Individual
MR. JACOB P ERDELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
13430 N MERIDIAN ST STE 367, CARMEL, IN 46032-1484
(317) 802-2000
(317) 569-0573
Mailing address
13430 N MERIDIAN ST STE 367, CARMEL, IN 46032-1484
(317) 802-2000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
28205845A
IN
363L00000X
Nurse Practitioner
71012274A
IN
363LF0000X
Family Nurse Practitioner
Primary
71012274A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9590909203
MEDICARE PTAN
IN
Enumeration date
11/23/2021
Last updated
08/31/2023
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