Individual
JENNIFER PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3113 N BROADWAY STREET, ANDERSON, IN 46012-1261
(765) 298-4660
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
11014885A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201110020
—
IN
01
—
P01723972
RR MEDICARE
IN
Enumeration date
07/12/2009
Last updated
11/27/2023
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