Provider Demographics
NPI:1093899858
Name:CARMEL FAMILY CARE, P.C.
Entity Type:Organization
Organization Name:CARMEL FAMILY CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-574-9090
Mailing Address - Street 1:12289 HANCOCK ST
Mailing Address - Street 2:SUITE 35
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5801
Mailing Address - Country:US
Mailing Address - Phone:317-574-9090
Mailing Address - Fax:317-574-1801
Practice Address - Street 1:12289 HANCOCK ST
Practice Address - Street 2:SUITE 35
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5801
Practice Address - Country:US
Practice Address - Phone:317-574-9090
Practice Address - Fax:317-574-1801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN210650Medicare ID - Type Unspecified