Provider Demographics
NPI:1982819017
Name:INDIANAPOLIS INSTITUTE FOR PLASTIC SURGERY
Entity Type:Organization
Organization Name:INDIANAPOLIS INSTITUTE FOR PLASTIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-859-3259
Mailing Address - Street 1:8051 S EMERSON AVE
Mailing Address - Street 2:STE 450
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8600
Mailing Address - Country:US
Mailing Address - Phone:317-859-3259
Mailing Address - Fax:317-859-3265
Practice Address - Street 1:8051 S EMERSON AVE
Practice Address - Street 2:STE 450
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8600
Practice Address - Country:US
Practice Address - Phone:317-859-3259
Practice Address - Fax:317-859-3265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010267752086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1033147525OtherPHYSICIAN INDIVIDUAL NPI
IN067770Medicare ID - Type Unspecified