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Individual

CODY MITCHEL JINNETTE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
1120 W MICHIGAN ST # CL630, INDIANAPOLIS, IN 46202-5209
(317) 278-2689
Mailing address
1120 W MICHIGAN ST # CL630, INDIANAPOLIS, IN 46202-5209

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
02006968A
IN
207RI0200X
Infectious Disease Physician
Primary
02006968A
IN
390200000X
Student in an Organized Health Care Education/Training Program

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1104197523
ANTHEM PTAN
IN
05
300092620
IN
Enumeration date
04/11/2019
Last updated
05/09/2025
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