Provider Demographics
NPI:1689416729
Name:INDIANA GROUP LLC
Entity type:Organization
Organization Name:INDIANA GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:BHIMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-557-8870
Mailing Address - Street 1:32 TIBBETTS RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-4622
Mailing Address - Country:US
Mailing Address - Phone:914-557-8870
Mailing Address - Fax:914-963-6019
Practice Address - Street 1:4668 SHELBY CIR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-7428
Practice Address - Country:US
Practice Address - Phone:914-557-8870
Practice Address - Fax:914-963-6019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty