Provider Demographics
NPI:1881895449
Name:INDIANA UNIVERSITY AND PURDUE UNIVERSITY
Entity type:Organization
Organization Name:INDIANA UNIVERSITY AND PURDUE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROFESSOR AND CHIEF
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:FLOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:317-630-8795
Mailing Address - Street 1:1001 W. 10TH ST. W-7123
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-630-8795
Mailing Address - Fax:317-630-8185
Practice Address - Street 1:1001 W 10TH ST # W-7123
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2859
Practice Address - Country:US
Practice Address - Phone:317-630-8795
Practice Address - Fax:317-630-8185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty