Individual
ANNETTE C DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
8714 SARGENT CREEK LN, INDIANAPOLIS, IN 46256-1376
(952) 595-1100
(612) 294-4903
Mailing address
11995 SINGLETREE LN, STE 500, EDEN PRAIRIE, MN 55344-5347
(952) 595-1301
(612) 294-4903
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
01056651
IN
2085R0202X
Diagnostic Radiology Physician
Primary
01056651
IN
Other
Enumeration date
06/04/2006
Last updated
08/31/2016
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