Individual
SCOTT CARL MIETHKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
(765) 448-7627
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01038378A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000185176
ANTHEM PROVIDER NUMBER
IN
05
—
100262390
—
IN
01
—
E43782
MEDICARE UPIN NUMBER
IN
05
—
MI91990011
—
IN
Enumeration date
03/15/2006
Last updated
01/27/2021
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