Individual
DR. SUSAN CALDECOTT-JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7120 CLEARVISTA DR, SUITE 5300, INDIANAPOLIS, IN 46256-1621
(317) 621-0104
(317) 621-0111
Mailing address
6626 E 75TH ST, 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
01043182A
IN
2081P0010X
Pediatric Rehabilitation Medicine Physician
Primary
01043182A
IN
2081P0010X
Pediatric Rehabilitation Medicine Physician
TEMPORARY
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000661927
ANTHEM
IN
05
—
200014600
—
IN
Enumeration date
10/02/2006
Last updated
03/13/2014
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