Provider Demographics
NPI:1609186402
Name:ENDOCRINOLOGY DIABETES AND OBESITY CLINIC
Entity Type:Organization
Organization Name:ENDOCRINOLOGY DIABETES AND OBESITY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIOS
Authorized Official - Middle Name:T
Authorized Official - Last Name:HERODOTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-706-6733
Mailing Address - Street 1:11805 N PENNSYLVANIA ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-4555
Mailing Address - Country:US
Mailing Address - Phone:317-706-6733
Mailing Address - Fax:317-706-6723
Practice Address - Street 1:11805 N PENNSYLVANIA ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4555
Practice Address - Country:US
Practice Address - Phone:317-706-6733
Practice Address - Fax:317-706-6723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty