Provider Demographics
NPI:1912030966
Name:LASER AND SKIN SURGERY CENTER OF INDIANA, P.C.
Entity Type:Organization
Organization Name:LASER AND SKIN SURGERY CENTER OF INDIANA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HANKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-660-4900
Mailing Address - Street 1:8925 N MERIDIAN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2385
Mailing Address - Country:US
Mailing Address - Phone:317-660-4900
Mailing Address - Fax:317-660-7112
Practice Address - Street 1:8925 N MERIDIAN ST STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2385
Practice Address - Country:US
Practice Address - Phone:317-660-4900
Practice Address - Fax:317-660-7112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207N00000X, 207ND0101X, 207ND0900X, 207NS0135X
IN50004010A261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INZJ0990Medicare ID - Type UnspecifiedASC