Individual
LAURA MARQUEZ LOPEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7979 N SHADELAND AVE STE 310, INDIANAPOLIS, IN 46250-2042
(765) 621-3780
(765) 621-3088
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10002039A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300005047
—
IN
01
—
P01678957
MEDICARE RR
IN
Enumeration date
03/22/2016
Last updated
02/08/2024
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