Provider Demographics
NPI:1326209313
Name:INDIANA UNIVESITY
Entity Type:Organization
Organization Name:INDIANA UNIVESITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FELLOW
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-274-1339
Mailing Address - Street 1:541 CLINICAL DR
Mailing Address - Street 2:CLINICAL BUILDING459
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5233
Mailing Address - Country:US
Mailing Address - Phone:317-274-1339
Mailing Address - Fax:317-278-0658
Practice Address - Street 1:541 CLINICAL DR
Practice Address - Street 2:CLINICAL BUILDING459
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5233
Practice Address - Country:US
Practice Address - Phone:317-274-1339
Practice Address - Fax:317-278-0658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11012325A282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital