Provider Demographics
NPI:1821402447
Name:UROGYN AND GYN WELLNESS
Entity Type:Organization
Organization Name:UROGYN AND GYN WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:UROGYNECOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:DANITA
Authorized Official - Middle Name:HARRISON
Authorized Official - Last Name:AKINGBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-661-1079
Mailing Address - Street 1:PO BOX 68108
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-0108
Mailing Address - Country:US
Mailing Address - Phone:317-661-1079
Mailing Address - Fax:844-661-1080
Practice Address - Street 1:2060 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-1762
Practice Address - Country:US
Practice Address - Phone:317-661-1079
Practice Address - Fax:844-661-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10667104174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty