Provider Demographics
NPI:1952979288
Name:IVISIT DOC INC
Entity Type:Organization
Organization Name:IVISIT DOC INC
Other - Org Name:APKAMD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF TECHNOLOGY
Authorized Official - Prefix:MR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:OBRIQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-561-9125
Mailing Address - Street 1:7345 WOODLAND DR STE 1
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1737
Mailing Address - Country:US
Mailing Address - Phone:877-843-2351
Mailing Address - Fax:317-981-6716
Practice Address - Street 1:7345 WOODLAND DR STE 1
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1737
Practice Address - Country:US
Practice Address - Phone:317-762-4025
Practice Address - Fax:317-759-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01054614AOtherINTERNAL MEDICINE LICENSE - IN