Individual
JAMES MARESH
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) 448-8027
Mailing address
1200 W WHITE RIVER BLVD, RCS PROVIDER ENROLLMENT, MUNCIE, IN 47903-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01066047A
IN
208600000X
Surgery Physician
4765
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000599708
ANTHEM PROVIDER NUMBER
IN
05
—
100088420
—
IN
Enumeration date
05/31/2006
Last updated
01/26/2021
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