Individual
LARRY T MICON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
13914 SOUTHEASTERN PKWY STE 202, FISHERS, IN 46037-7125
(800) 477-0233
Mailing address
10330 N MERIDIAN ST # 300, INDIANAPOLIS, IN 46290-1024
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01031976A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100088600
—
IN
Enumeration date
06/20/2006
Last updated
05/03/2018
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