Provider Demographics
NPI:1538460191
Name:INDIANA UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY MEDICAL CENTER
Other - Org Name:INDIANA UNIVERSITY HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:ERCP FELLOW
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMIEN
Authorized Official - Middle Name:MY
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-625-0710
Mailing Address - Street 1:927 PACA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2914
Mailing Address - Country:US
Mailing Address - Phone:317-625-0710
Mailing Address - Fax:
Practice Address - Street 1:927 PACA ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2914
Practice Address - Country:US
Practice Address - Phone:317-625-0710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-12
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11015282A284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital