MEDICARE: MARY JEANETTE STEELE MD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	2080H0002X	Pediatric Hospice and Palliative Medicine Physician	2021-00580	NC

General Provider Information

NPI Number	:	1336637339
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JEANETTE STEELE MD

Provider Business Mailing Address
First Line	:	4406 CARROLLTON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46205-1916
Country	:	US
Telephone Number	:	812-447-9716
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 RILEY HOSPITAL DR RM 5867
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5109
Country	:	US
Telephone Number	:	317-944-4034
Fax Number	:

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

Provider Enumeration Date	:	04/25/2018
Last Update Date	:	05/08/2023

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