Provider Demographics
NPI:1336342823
Name:GASTROENTEROLOGY OF INDIANAPOLIS, P.C.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY OF INDIANAPOLIS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-848-5494
Mailing Address - Street 1:1120 AAA WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3210
Mailing Address - Country:US
Mailing Address - Phone:317-848-5494
Mailing Address - Fax:317-575-0392
Practice Address - Street 1:1120 AAA WAY
Practice Address - Street 2:SUITE A
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3210
Practice Address - Country:US
Practice Address - Phone:317-848-5494
Practice Address - Fax:317-575-0392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50002705A207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN312930Medicare PIN