Healthcare Provider Details

I. General information

NPI: 1609446475
Provider Name (Legal Business Name): MICHELLE LOUISE LOVELACE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 N MERIDIAN ST STE 101
CARMEL IN
46032-1404
US

IV. Provider business mailing address

13000 N MERIDIAN ST STE 101
CARMEL IN
46032-1404
US

V. Phone/Fax

Practice location:
  • Phone: 317-848-1402
  • Fax: 317-575-6912
Mailing address:
  • Phone: 317-848-1402
  • Fax: 317-575-6912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10003521
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: