Individual
COREY JOSEPH MITSCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
1111 RONALD REAGAN PKWY, AVON, IN 46123-7085
(317) 217-3000
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
75000123A
IN
367H00000X
Anesthesiologist Assistant
Primary
75000123A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102864817
ANTHEM PTAN
IN
01
—
Q00784103
RAILROAD PTAN
IN
Enumeration date
01/18/2023
Last updated
12/04/2024
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