Individual
DR. MARY D ROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6640 INTECH BLVD, SUITE 195, INDIANAPOLIS, IN 46278-2011
(317) 295-0608
(317) 295-0622
Mailing address
6640 INTECH BLVD, STE 195, INDIANAPOLIS, IN 46278-2011
(317) 295-0608
(317) 295-0622
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
01040728
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100357530
—
IN
Enumeration date
06/21/2006
Last updated
12/01/2014
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