Healthcare Provider Details

I. General information

NPI: 1487659835
Provider Name (Legal Business Name): JOHN M HUSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 01/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13430 N MERIDIAN ST SUITE 275
CARMEL IN
46032-1405
US

IV. Provider business mailing address

13430 N MERIDIAN ST SUITE 275
CARMEL IN
46032-1405
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-8815
  • Fax: 317-582-8825
Mailing address:
  • Phone: 317-582-8815
  • Fax: 317-582-8825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01024414A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: