Individual
MICHAEL J DETKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5018 SAINT CHARLES PL, CARMEL, IN 46033-5940
(317) 902-2002
Mailing address
5018 SAINT CHARLES PL, CARMEL, IN 46033-5940
(317) 902-2002
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01052665
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200315250
—
IN
01
—
260046994
RAILROAD MEDICARE
IN
Enumeration date
06/02/2006
Last updated
08/07/2014
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