Provider Demographics
NPI:1295000917
Name:INDIANA SPINE GROUP, PC
Entity Type:Organization
Organization Name:INDIANA SPINE GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:HARDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-228-7000
Mailing Address - Street 1:13225 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5480
Mailing Address - Country:US
Mailing Address - Phone:317-228-7000
Mailing Address - Fax:317-228-2321
Practice Address - Street 1:112 HOSPITAL LN
Practice Address - Street 2:BLDG. 2, SUTE 301
Practice Address - City:DANVILLE
Practice Address - State:IN
Practice Address - Zip Code:46122-1977
Practice Address - Country:US
Practice Address - Phone:317-228-7000
Practice Address - Fax:317-228-2321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA SPINE GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-13
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200359410Medicaid
IN200359410Medicaid