MEDICARE: MICHAEL J DETKE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	01052665	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	260046994	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275570558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL J DETKE M.D.

Provider Business Mailing Address
First Line	:	5018 SAINT CHARLES PL
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46033-5940
Country	:	US
Telephone Number	:	317-902-2002
Fax Number	:

Provider Business Practice Location Address
First Line	:	5018 SAINT CHARLES PL
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46033-5940
Country	:	US
Telephone Number	:	317-902-2002
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	08/07/2014

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