Healthcare Provider Details

I. General information

NPI: 1225170947
Provider Name (Legal Business Name): CAROLINE A SITZMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 02/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11725 N ILLINOIS ST STE 250
CARMEL IN
46032-3015
US

IV. Provider business mailing address

250 N SHADELAND AVE STE 130 - PROVIDER ENROLLMENT
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-688-5300
  • Fax: 317-688-5313
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10000284A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: