Provider Demographics
NPI:1275802993
Name:CERTIFIED PHYSICIAN SOLUTIONS
Entity Type:Organization
Organization Name:CERTIFIED PHYSICIAN SOLUTIONS
Other - Org Name:CERTIFIED PHYSICIAN SOLUTIONS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:II
Authorized Official - Credentials:DO
Authorized Official - Phone:574-304-0428
Mailing Address - Street 1:541 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3513
Mailing Address - Country:US
Mailing Address - Phone:574-304-0428
Mailing Address - Fax:317-602-7166
Practice Address - Street 1:541 N PARK AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3513
Practice Address - Country:US
Practice Address - Phone:574-304-0428
Practice Address - Fax:317-602-7166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003296A207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty