Individual
MIKALA WADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
212 S 12TH AVE, BEECH GROVE, IN 46107-1717
(317) 724-3228
Mailing address
212 S 12TH AVE, BEECH GROVE, IN 46107-1717
(317) 724-3228
Taxonomy
Speciality
Code
Description
License number
State
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
1230965914
IN
Other
Enumeration date
07/18/2023
Last updated
07/18/2023
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