Individual
MADELINE STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7250 CLEARVISTA DR STE 330, INDIANAPOLIS, IN 46256-5601
(317) 621-5204
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-9312
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300020984
—
IN
01
—
P02198437
MEDICARE RR
IN
Enumeration date
09/27/2018
Last updated
01/23/2024
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