Individual
GRAINNE M O'MALLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
253 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1501
(708) 714-4378
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01080931A
IN
207R00000X
Internal Medicine Physician
125067889
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001199850
ANTHEM
—
05
—
300019370
—
IN
Enumeration date
07/17/2015
Last updated
07/03/2023
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