Individual
JUDIANN MISKULIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
757 MASSACHUSETTS AVE UNIT 402, INDIANAPOLIS, IN 46204-1692
(317) 000-0000
Mailing address
757 MASSACHUSETTS AVE UNIT 402, INDIANAPOLIS, IN 46204-1692
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01061067A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000386158
ANTHEM PIN
IN
05
—
200529890
—
IN
01
—
P01824517
RR MEDICARE
IN
Enumeration date
04/27/2006
Last updated
11/01/2023
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