Individual
KATIE JO STANTON-MAXEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
720 ESKENAZI AVE, INDIANAPOLIS, IN 46202-5166
(317) 880-5048
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
(317) 963-0860
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01062144A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000660367
ANTHEM PIN
IN
05
—
200984160
—
IN
Enumeration date
06/04/2008
Last updated
07/09/2014
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