Individual
DR. JOHN MARK MICHAEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
242 WILLOWGATE LN, INDIANAPOLIS, IN 46260-1431
(317) 848-1611
Mailing address
242 WILLOWGATE LN, INDIANAPOLIS, IN 46260-1431
(317) 848-1611
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
01033505
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100317670
—
IN
01
—
180007434
RAILROAD MEDICARE
IN
Enumeration date
06/09/2005
Last updated
03/04/2016
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