Healthcare Provider Details

I. General information

NPI: 1316191190
Provider Name (Legal Business Name): MERIDIAN PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2008
Last Update Date: 11/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12065 OLD MERIDIAN ST SUITE 100
CARMEL IN
46032-8773
US

IV. Provider business mailing address

12065 OLD MERIDIAN ST SUITE 100
CARMEL IN
46032-8773
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-5351
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01043902
License Number StateIN

VIII. Authorized Official

Name: JILL MAUZREK
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 317-844-5351