Provider Demographics
NPI:1356790042
Name:SISKIN PHYSICIANS LLC
Entity type:Organization
Organization Name:SISKIN PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:T
Authorized Official - Last Name:CREESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-526-6797
Mailing Address - Street 1:155 E MARKET ST
Mailing Address - Street 2:700
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-3294
Mailing Address - Country:US
Mailing Address - Phone:800-526-6797
Mailing Address - Fax:
Practice Address - Street 1:1941 VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-2833
Practice Address - Country:US
Practice Address - Phone:765-825-5131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-03
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty