Individual
JENNIFER M MARDOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
380 S JUNCTION XING, SUITE 100, WESTFIELD, IN 46074-7852
(317) 399-3550
(317) 399-3555
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02004717A
IN
207Q00000X
Family Medicine Physician
34.009993
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0056264
—
OH
05
—
201337360
—
IN
Enumeration date
07/11/2006
Last updated
12/17/2020
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