Healthcare Provider Details

I. General information

NPI: 1023378437
Provider Name (Legal Business Name): JOANNA LEE HUNTER-SQUIRES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA LEE HUNTER M.D.

II. Dates (important events)

Enumeration Date: 05/18/2012
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 RONALD REAGAN PKWY
AVON IN
46123-7085
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-7874
  • Fax: 317-944-7874
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA148776
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01078350A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: