Individual
DR. MARIO JOSE PADRON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
355 W 16TH ST STE 2364, INDIANAPOLIS, IN 46202-2279
(317) 274-8157
Mailing address
355 W 16TH ST STE 2364, INDIANAPOLIS, IN 46202-2279
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
1710628284
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02007370A
STATE LICENSE
IN
Enumeration date
04/06/2022
Last updated
09/12/2024
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