Individual
KYLE J MAZELLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6964 HILLSDALE CT, INDIANAPOLIS, IN 46250
(317) 621-9292
(317) 621-9299
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-7588
(317) 957-2749
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
01080324A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260180B99
MEDICARE
IN
05
—
300015972
—
IN
01
—
P02085739
RAIDROAD MEDICARE
IN
Enumeration date
04/04/2014
Last updated
11/27/2023
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