Individual
DR. MANUEL G RIVERA MAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2525 W UNIVERSITY AVE STE 300, MUNCIE, IN 47303-3432
(765) 289-5420
(765) 281-2065
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01089549A
IN
207RC0000X
Cardiovascular Disease Physician
01089549A
IN
207RI0011X
Interventional Cardiology Physician
Primary
01089549A
IN
390200000X
Student in an Organized Health Care Education/Training Program
2019016629
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300074529
—
IN
01
—
M122404071
MEDICARE PTAN
IN
Enumeration date
06/17/2015
Last updated
08/09/2023
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