Provider Demographics
NPI:1962652644
Name:LARRY N MONN, MD INC
Entity Type:Organization
Organization Name:LARRY N MONN, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:N
Authorized Official - Last Name:MONN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-621-3900
Mailing Address - Street 1:8040 CLEARVISTA PKWY
Mailing Address - Street 2:SUITE 540
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-5630
Mailing Address - Country:US
Mailing Address - Phone:317-621-3900
Mailing Address - Fax:317-621-3902
Practice Address - Street 1:8040 CLEARVISTA PKWY
Practice Address - Street 2:SUITE 540
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5630
Practice Address - Country:US
Practice Address - Phone:317-621-3900
Practice Address - Fax:317-621-3902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021544A2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN063980Medicare PIN