Individual
STACIA L GROOVER MALTBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1411 S GREEN ST, SUITE 130, BROWNSBURG, IN 46112-2049
(317) 858-4610
(317) 858-4620
Mailing address
1100 SOUTHFIELD DR, SUITE 1370, PLAINFIELD, IN 46168-4498
(317) 837-5571
(317) 837-5580
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01051320A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200342300
—
IN
Enumeration date
09/15/2005
Last updated
03/05/2021
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