Healthcare Provider Details

I. General information

NPI: 1336116045
Provider Name (Legal Business Name): ERIC A GIRARDOT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13225 N MERIDIAN ST
CARMEL IN
46032-5480
US

IV. Provider business mailing address

13225 N MERIDIAN ST
CARMEL IN
46032-5480
US

V. Phone/Fax

Practice location:
  • Phone: 317-715-4863
  • Fax: 317-795-2047
Mailing address:
  • Phone: 317-228-7000
  • Fax: 317-228-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1000557A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: