Individual
MARIO ROLANDO CONTRERAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2400 SOUTH ST, LAFAYETTE, IN 47904-3027
(765) 448-4319
(765) 448-2921
Mailing address
PO BOX 5628, LAFAYETTE, IN 47903-5628
(765) 448-4319
(765) 448-2921
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01036557A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082509
ANTHEM
IN
01
—
CB5232
RAILROAD MEDICARE
IN
Enumeration date
07/06/2005
Last updated
07/16/2007
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