EAGLE CREEK DERMATOLOGY (NPI# 1053561928) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053561928 |
| Entity Type | Organization |
| Organization Name | EAGLE CREEK DERMATOLOGY |
| Practice Address |
6820 Parkdale Pl Suite 211 Indianapolis IN 46254-6600 |
| Practice Telephone | 3173297050 |
| Practice Fax Number | 3173286809 |
| Mailing Telephone | 3173297050 |
| Mailing Fax Number | 3173286809 |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2013-09-11 |
| Authorized Official Name | DR. INGRIDA IVETA OZOLS (PARTNER) |
| Authorized Official Telephone | 3173297050 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | 01027554 | IN | Allopathic & Osteopathic Physicians |
| N | 207NI0002X |
Dermatology Specialization: Clinical & Laboratory Dermatological Immunology |
01057248 | IN | Allopathic & Osteopathic Physicians |
| Y | 207NI0002X |
Dermatology Specialization: Clinical & Laboratory Dermatological Immunology |
01024873 | IN | Allopathic & Osteopathic Physicians |
| Street Address |
6820 PARKDALE PL SUITE 211 |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46254-6600 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285603886 | Stephen F Eberwine | Internal Medicine | 6820 Parkdale Pl, Suite 200, Indianapolis, IN 46254-6601 | 2006-03-16 |
| 1114375052 | Fatema Sabri Alqudaihi | Dentist | 6820 Parkdale Pl, Indianapolis, IN 46254-6601 | 2016-06-01 |
| 1164692968 | Wilshire Medical P.C. | Obstetrics & Gynecology | 6820 Parkdale Pl, Ste 212, Indianapolis, IN 46254-6601 | 2008-03-07 |
| 1245408111 | Kelley G Rogers | Nurse Practitioner | 6820 Parkdale Pl, Suite 212, Indianapolis, IN 46254-6601 | 2008-02-13 |
| 1417125386 | Sandra K Vanwye | Nurse Practitioner | 6820 Parkdale Pl, Suite 212, Indianapolis, IN 46254-6601 | 2008-02-13 |
| 1790964914 | Indiana Mothers' Milk Bank, Inc | Durable Medical Equipment & Medical Supplies | 6820 Parkdale Pl, Suite 109, Indianapolis, IN 46254-6601 | 2007-10-25 |
| 1184844698 | American Health Network of Indiana, LLC | Durable Medical Equipment & Medical Supplies | 6820 Parkdale Pl, Suite 105, Indianapolis, IN 46254-6601 | 2007-04-26 |
| 1376668780 | American Health Network of Indiana, LLC | Psychiatry & Neurology | 6820 Parkdale Pl, Suite 105, Indianapolis, IN 46254-6601 | 2007-03-21 |
| 1992842363 | Samia R Shaikh- Milharcic | Dentist | 6820 Parkdale Pl, Suite 117, Indianapolis, IN 46254-6601 | 2007-02-01 |
| 1669523007 | Dawn A Collins | Marriage & Family Therapist | 6820 Parkdale Pl, Suite 209, Indianapolis, IN 46254-6601 | 2007-01-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427673052 | Sanders Empowerment Services LLC | Social Worker | 5026 Clarkson Drive, Indianapolis, IN 46254 | 2020-06-09 |
| 1316587660 | Yulisa Carrera-ochoa | Behavior Technician | 6925 Parkdale Place, Indianapolis, IN 46254 | 2020-01-14 |
| 1396230140 | Emeri Taivalkoski | Registered Nurse | Eskenazi Health West 38th Street, 5515 38th St, Indianapolis, IN 46254 | 2018-06-25 |
| 1811499759 | Sara Peterson | Speech-Language Pathologist | 4102 Shore Drive, Indianapolis, IN 46254 | 2018-03-07 |
| 1427560002 | Swan Garden Home Services LLC | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 4906 Quail Ridge Ln, Indianapolis, IN 46254 | 2017-11-03 |
| 1477083475 | Sherry Mason | Counselor | 5959 Staffordshire Cir, Indianapolis, IN 46254 | 2017-06-13 |
| 1790111680 | The Health and Hospital Corporation of Marion County | Pharmacy | 5515 W 38th St Ste 1200, Indianapolis, IN 46254 | 2013-09-24 |
| 1790051563 | Theracare | Skilled Nursing Facility | 5356 Holly Springs Ct, Indianapolis, IN 46254 | 2012-03-27 |
| 1750659827 | Apollon | Counselor | 5362 Deer Creek Drive, Indianapolis, IN 46254 | 2011-12-05 |
| 1235413253 | Irene Williams | Pharmacist | 6269 W. 38th St, Indianapolis, IN 46254 | 2011-10-10 |
| Find all providers in zip 46254 | ||||
| Taxonomy Code | 207NI0002X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | Clinical & Laboratory Dermatological Immunology |
| A dermatologist who utilizes various specialized laboratory procedures to diagnose disorders characterized by defective responses of the body's immune system. Immunodermatologists also may provide consultation in the management of these disorders and administer specialized forms of therapy for these diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427145986 | Wendy Meade Wilson | Dermatology | 6820 Parkdale Place, Suite 211, Indianapolis, IN 46254-6600 | 2006-10-06 |
| City | INDIANAPOLIS |
| Zip Code | 46254 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.