Individual
STACIE K HIROTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
17160 DRAGONFLY DR, NOBLESVILLE, IN 46060-3632
(317) 678-2600
(317) 678-2610
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
02006097A
IN
207R00000X
Internal Medicine Physician
02006097A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300041008
—
IN
Enumeration date
04/10/2016
Last updated
05/24/2025
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