Individual
TARA LYNN SPIVEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1210 MEDICAL ARTS BLVD STE 203, ANDERSON, IN 46011-3437
(765) 298-4767
(765) 298-4768
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
125-061831
IL
2086X0206X
Surgical Oncology Physician
Primary
01080751A
IN
2086X0206X
Surgical Oncology Physician
269869
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300016422
—
IN
Enumeration date
06/27/2012
Last updated
11/17/2022
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