Provider Demographics
NPI:1790757466
Name:EAPEN, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:EAPEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-9312
Mailing Address - Fax:317-621-6920
Practice Address - Street 1:9669 E 146TH ST STE 200
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5008
Practice Address - Country:US
Practice Address - Phone:317-621-6300
Practice Address - Fax:317-621-6310
Is Sole Proprietor?:No
Enumeration Date:2006-02-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01063289A207R00000X, 209800000X, 207R00000X
IN01063289208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No209800000XAllopathic & Osteopathic PhysiciansLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000638746OtherANTHEM
IN200856040Medicaid
IN000000638746OtherANTHEM
IN260690B3Medicare PIN
IN200856040Medicaid
ILI04851Medicare UPIN