Individual
STACEY L HALUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1185 W CARMEL DR, SUITE D-5, CARMEL, IN 46032-8706
(317) 450-4180
(317) 324-3950
Mailing address
PO BOX 7045, INDIANAPOLIS, IN 46207-7045
(317) 450-4180
(317) 324-3950
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01061360A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IN1585
MEDICARE PTAN
IN
Enumeration date
06/26/2006
Last updated
02/07/2014
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