Provider Demographics
NPI:1417268608
Name:PIKE, DAVID EDWARD (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWARD
Last Name:PIKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 WESTFIELD RD
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1434
Mailing Address - Country:US
Mailing Address - Phone:317-776-7250
Mailing Address - Fax:317-776-7255
Practice Address - Street 1:395 WESTFIELD RD
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1434
Practice Address - Country:US
Practice Address - Phone:317-776-7250
Practice Address - Fax:317-776-7255
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN02003942A207P00000X
OH34.012274207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300016899Medicaid