Provider Demographics
NPI:1841400371
Name:BLACK, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:BLACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8 NORTH US 31
Mailing Address - Street 2:SUITE B
Mailing Address - City:WHITELAND
Mailing Address - State:IN
Mailing Address - Zip Code:46184-1546
Mailing Address - Country:US
Mailing Address - Phone:317-787-6566
Mailing Address - Fax:317-888-6766
Practice Address - Street 1:8 NORTH US 31
Practice Address - Street 2:SUITE B
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-1546
Practice Address - Country:US
Practice Address - Phone:317-787-6566
Practice Address - Fax:317-888-6766
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2022-02-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01034170207RG0100X
IN01034170A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100217860Medicaid
IN100217860AMedicaid