Organization
STEPHEN J. MASSICOTTE, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN JOHN MASSICOTTE M.D. (PRESIDENT)
(317) 280-8410
Entity
Organization
Contact information
Practice address
3955 EAGLE CREEK PKWY, SUITE C, INDIANAPOLIS, IN 46254-5615
(317) 280-8410
(317) 280-8414
Mailing address
3955 EAGLE CREEK PKWY, SUITE C, INDIANAPOLIS, IN 46254-5615
(317) 280-8410
(317) 280-8414
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01039382A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100177550
—
IN
Enumeration date
02/14/2007
Last updated
07/26/2014
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