Provider Demographics
NPI:1801399100
Name:EXTENDED CARE MEDICAL DOCTORS
Entity Type:Organization
Organization Name:EXTENDED CARE MEDICAL DOCTORS
Other - Org Name:ECMD
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:M M NOOR US
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:346-208-2408
Mailing Address - Street 1:10475 CROSSPOINT BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3387
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10475 CROSSPOINT BLVD STE 250
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3387
Practice Address - Country:US
Practice Address - Phone:317-813-5047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 207RE0101X
IN207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty