Provider Demographics
NPI:1831154863
Name:EDMONDSON, JAMES W (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:EDMONDSON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1100 SOUTHFIELD DR
Mailing Address - Street 2:SUITE 1370
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4498
Mailing Address - Country:US
Mailing Address - Phone:317-837-5571
Mailing Address - Fax:317-837-5580
Practice Address - Street 1:100 HOSPITAL LN
Practice Address - Street 2:SUITE 205
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5112
Practice Address - Country:US
Practice Address - Phone:317-745-7445
Practice Address - Fax:317-745-7449
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-03-04
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Provider Licenses
StateLicense IDTaxonomies
IN01022719207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100277890Medicaid
INB28189Medicare UPIN
IN100277890Medicaid