Individual
H CARL MOULTRIE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
255 E 90TH DR, SUITE W1, MERRILLVILLE, IN 46410
(219) 793-9029
(219) 793-9101
Mailing address
PO BOX 10727, MERRILLVILLE, IN 46411-0727
(219) 793-9029
(219) 793-9101
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01026965A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000186722
ANTHEM
IN
01
—
4513204
AETNA
—
Enumeration date
07/18/2005
Last updated
07/08/2007
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