Provider Demographics
NPI:1356096788
Name:DERMATOLOGY CENTER OF INDIANA PC
Entity Type:Organization
Organization Name:DERMATOLOGY CENTER OF INDIANA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GUENTHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-838-9911
Mailing Address - Street 1:2800 S STATE ROAD 135 STE 250
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-6223
Mailing Address - Country:US
Mailing Address - Phone:317-203-5884
Mailing Address - Fax:
Practice Address - Street 1:2800 S STATE ROAD 135 STE 250
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-6223
Practice Address - Country:US
Practice Address - Phone:317-203-5884
Practice Address - Fax:317-743-8103
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE DERMATOLOGY CENTER OF INDIANA PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty