Provider Demographics
NPI:1760642805
Name:INDIANA UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF SURGERY
Entity Type:Organization
Organization Name:INDIANA UNIVERSITY SCHOOL OF MEDICINE DEPARTMENT OF SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGERY RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:BOOTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-312-0270
Mailing Address - Street 1:10180 ARROWHEAD CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46234-3649
Mailing Address - Country:US
Mailing Address - Phone:317-457-0821
Mailing Address - Fax:
Practice Address - Street 1:545 BARNHILL DR
Practice Address - Street 2:EMERSON HALL ROOM 202
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-274-4966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11011531A282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital