Provider Demographics
NPI:1659716017
Name:INDIANA UNIVERSITY SCHOOL OF MEDICINE
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY SCHOOL OF MEDICINE
Other - Org Name:IU/METHODIST FAMILY MEDICINE RESIDENCY
Other - Org Type:Other Name
Authorized Official - Title/Position:RESIDENCY COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOUDREAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-962-5423
Mailing Address - Street 1:1655 LEXINGTON RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-9795
Mailing Address - Country:US
Mailing Address - Phone:859-559-2341
Mailing Address - Fax:
Practice Address - Street 1:1520 N SENATE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2213
Practice Address - Country:US
Practice Address - Phone:859-559-2341
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital