Provider Demographics
NPI:1770959520
Name:DERMATOLOGY ASSOCIATES OF INDY LLC
Entity type:Organization
Organization Name:DERMATOLOGY ASSOCIATES OF INDY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:NEVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-492-6333
Mailing Address - Street 1:6966 S UTICA AVE
Mailing Address - Street 2:STE. 225
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-3903
Mailing Address - Country:US
Mailing Address - Phone:855-492-6333
Mailing Address - Fax:918-493-9405
Practice Address - Street 1:1700 W SMITH VALLEY RD
Practice Address - Street 2:STE. B
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1599
Practice Address - Country:US
Practice Address - Phone:855-492-6333
Practice Address - Fax:918-493-9405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty