Healthcare Provider Details

I. General information

NPI: 1871635326
Provider Name (Legal Business Name): JERROLD ARON LASKIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 03/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12425 OLD MERIDIAN ST SUITE B1
CARMEL IN
46032-8724
US

IV. Provider business mailing address

12425 OLD MERIDIAN ST SUITE B1
CARMEL IN
46032-8724
US

V. Phone/Fax

Practice location:
  • Phone: 317-706-9600
  • Fax: 317-706-9606
Mailing address:
  • Phone: 317-706-9600
  • Fax: 317-706-9606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number01040371
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: