Healthcare Provider Details

I. General information

NPI: 1750534368
Provider Name (Legal Business Name): MARY IAN MCATEER, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
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: 317-844-0310
Mailing address:
  • Phone: 317-844-5351
  • Fax: 317-844-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberIN-023535
License Number StateIN

VIII. Authorized Official

Name: MARY IAN MCATEER
Title or Position: OWNER
Credential: MD
Phone: 317-844-5351