EAGLE CREEK DERMATOLOGY NPI 1053561928

NPI Information

  • NPI: 1053561928
  • Provider Name: EAGLE CREEK DERMATOLOGY
  • Classification: Dermatology - 207NI0002X
  • Specialization: Clinical & Laboratory Dermatological Immunology
  • Entity Type: Organization
  • CLIA Number: 15D0687550
  • Address: 6820 PARKDALE PL
    SUITE 211
    INDIANAPOLIS, IN
    ZIP 46254
  • Phone: (317) 329-7050

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NPI Details

EAGLE CREEK DERMATOLOGY is a clinical and laboratory dermatological immunology dermatology in Indianapolis, IN. The provider is 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. EAGLE CREEK DERMATOLOGY NPI is 1053561928. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

6820 PARKDALE PL
SUITE 211
INDIANAPOLIS, IN
ZIP 46254-600
Phone: (317) 329-7050
Fax: (317) 328-6809

The provider's authorized official is Ingrida Iveta Ozols .
The authorized official title is Partner and has the following contact phone number (317) 329-7050.

The CLIA number assigned to this NPI record is 15D0687550 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 9/26/2008 and was last updated on 9/11/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207N00000XDermatology01027554INDIANANo
2207NI0002XDermatologyClinical & Laboratory Dermatological Immunology01057248INDIANANo
3207NI0002XDermatologyClinical & Laboratory Dermatological Immunology01024873INDIANAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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