Provider Demographics
NPI:1316013576
Name:EAGLE CREEK INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:EAGLE CREEK INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:VLAHOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-328-6333
Mailing Address - Street 1:5471 GEORGETOWN RD
Mailing Address - Street 2:STE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5794
Mailing Address - Country:US
Mailing Address - Phone:317-328-6333
Mailing Address - Fax:317-328-6330
Practice Address - Street 1:5471 GEORGETOWN RD
Practice Address - Street 2:STE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5794
Practice Address - Country:US
Practice Address - Phone:317-328-6333
Practice Address - Fax:317-328-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty