Individual
PETRA JOLLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1835 N MERIDIAN ST, INDIANAPOLIS, IN 46202-1411
(317) 931-3005
(317) 931-3063
Mailing address
3401 E RAYMOND ST, INDIANAPOLIS, IN 46203-4744
(317) 788-6970
(317) 781-4900
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01068948A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201004180
—
IN
Enumeration date
12/02/2010
Last updated
05/17/2011
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