Provider Demographics
NPI:1134315948
Name:ENDO-INDY, INC.
Entity Type:Organization
Organization Name:ENDO-INDY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MCCUNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-745-6305
Mailing Address - Street 1:998 E MAIN ST STE 104
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46122-1900
Mailing Address - Country:US
Mailing Address - Phone:317-745-6305
Mailing Address - Fax:317-298-8064
Practice Address - Street 1:998 E MAIN ST STE 104
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1900
Practice Address - Country:US
Practice Address - Phone:317-745-6305
Practice Address - Fax:317-298-8064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-15
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01023945A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN343050AMedicare PIN
IN343050Medicare PIN