Individual
DR. MICHAEL CHRISTOPHER LARGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
14300 E 138TH STE A, FISHERS, IN 46037-0087
(317) 813-1660
(317) 813-1667
Mailing address
679 E COUNTY LINE RD, GREENWOOD, IN 46143-1049
(317) 885-1250
(317) 859-4268
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01072896A
IN
208800000X
Urology Physician
125-049267
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000826877
ANTHEM PIN
IN
01
—
100194370
GROUP MEDICAID NUMBER
IN
01
—
1487680518
GROUP NPI
IN
01
—
1548340177
NAAB ROAD DME NPI
IN
01
—
200288740
GROUP MEDICAID NUMBER
IN
05
—
201191980
—
IN
Enumeration date
02/11/2009
Last updated
01/19/2024
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