Individual
MR. MICHAEL J MASTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
1047435
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
28135627A
IN
367500000X
Certified Registered Nurse Anesthetist
RN147036
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000322995
ANTHEM
IN
01
—
000000600814
ANTHEM PROVIDER NUMBER
IN
05
—
0855972
—
OH
05
—
200140860
—
IN
05
—
74337387
—
KY
Enumeration date
12/15/2005
Last updated
05/26/2011
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