Individual
SAMANTHA MARY KAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1633 N CAPITOL AVE, INDIANAPOLIS, IN 46202-1261
(317) 963-0600
(317) 963-0615
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01087842A
IN
207R00000X
Internal Medicine Physician
11020152A
IN
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
01087842A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
264430E46
MEDICARE PTAN
IN
05
—
300015322
—
IN
Enumeration date
06/23/2018
Last updated
04/09/2026
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