Individual
MICHAEL J WADDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5230 E STOP 11 RD STE 150, INDIANAPOLIS, IN 46237-6399
(317) 865-5904
(317) 865-5321
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
01061407A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000973567
ANTHEM
—
01
—
11723372
CAQH
—
05
—
200442410
—
IN
Enumeration date
07/17/2006
Last updated
09/26/2023
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