Healthcare Provider Details

I. General information

NPI: 1508843657
Provider Name (Legal Business Name): THOMAS A MABEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14535A HAZEL DELL PKWY
CARMEL IN
46033-9401
US

IV. Provider business mailing address

PO BOX 869
NOBLESVILLE IN
46061-0869
US

V. Phone/Fax

Practice location:
  • Phone: 317-705-4365
  • Fax: 317-705-4361
Mailing address:
  • Phone: 317-770-6900
  • Fax: 317-770-6911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01023348
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: