Individual
DR. PRISCILLA M DE LA CRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1120 W MICHIGAN STREET, GATCH HALL CL 285, INDIANAPOLIS, IN 46202
(317) 278-0042
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
01083580A
IN
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
MD2024-0300
NM
207RP1001X
Pulmonary Disease Physician
01083580A
IN
207RP1001X
Pulmonary Disease Physician
Primary
MD2024-0300
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
267030312
MEDICARE PTAN
IN
05
—
300037383
—
IN
Enumeration date
04/27/2017
Last updated
08/26/2024
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