Individual
JESSICA M KANIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
705 RILEY DRIVE, INDIANAPOLIS, IN 46202-5109
(317) 944-3936
(317) 948-5844
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
01072885A
IN
208000000X
Pediatrics Physician
35.094922
OH
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
01072885A
IN
2083C0008X
Clinical Informatics Physician
01072885A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000835642
ANTHEM PIN
IN
05
—
201057370
—
IN
Enumeration date
10/17/2006
Last updated
03/12/2025
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