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Individual

MATTHEW F WACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1633 N CAPITOL AVE, SUITE 750, INDIANAPOLIS, IN 46202-1270
(317) 962-0953
(317) 962-2455
Mailing address
250 N SHADELAND AVE, SUITE 130, INDIANAPOLIS, IN 46219-4959
(317) 587-2300
(317) 587-2342

Taxonomy

Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
01047042A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200139350
IN
Enumeration date
06/03/2006
Last updated
01/19/2016
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