Individual
KATHERINE IRENE BOONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5255 E STOP 11 RD STE 450, INDIANAPOLIS, IN 46237-6342
(317) 865-4800
(317) 865-4806
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
10001000A
IN
363AS0400X
Surgical Physician Assistant
99032721A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300007527
—
IN
01
—
M400063087
MEDICARE
IN
Enumeration date
06/05/2008
Last updated
03/21/2023
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