Individual
MARK ROLLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1011 MAIN STREET, SUITE 140, INDIANAPOLIS, IN 46224-6970
(317) 957-9000
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01056301A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000548671
BLUE CROSS INDIANA
—
01
—
01056301
STATE LICENSE
IN
05
—
200385470
—
IN
Enumeration date
11/09/2005
Last updated
11/27/2023
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