Healthcare Provider Details

I. General information

NPI: 1700220720
Provider Name (Legal Business Name): JENNIFER BALANDRAN BOYLE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER BALANDRAN

II. Dates (important events)

Enumeration Date: 04/21/2013
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 N MERIDIAN ST
CARMEL IN
46032
US

IV. Provider business mailing address

3500 GASTON AVE
DALLAS TX
75246-2017
US

V. Phone/Fax

Practice location:
  • Phone: 317-688-2000
  • Fax:
Mailing address:
  • Phone: 214-820-2361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR7958
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10047403
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01080958B
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: