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NPI Code Detail

MEDICARE: AUDREY DEVINE MD

MEDICARE: AUDREY DEVINE 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
1390200000XStudent in an Organized Health Care Education/Training Program11019470AIN
2207RR0500XRheumatology Physician01085094AIN
3207R00000XInternal Medicine Physician01085094AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1266180L38OTHERMEDICARE

Other Identifiers

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

General Provider Information

NPI Number : 1588194039
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY DEVINE MD
Provider Business Mailing Address
First Line : 6626 E 75TH ST STE 500
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-2890
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1270 N POST RD STE B
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4254
Country : US
Telephone Number : 317-999-9999
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2017
Last Update Date : 03/08/2024

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