Healthcare Provider Details

I. General information

NPI: 1902434251
Provider Name (Legal Business Name): JEREMIAH R DALLMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11700 N MERIDIAN ST
CARMEL IN
46032-4656
US

IV. Provider business mailing address

535 BARNHILL DR
INDIANAPOLIS IN
46202-5116
US

V. Phone/Fax

Practice location:
  • Phone: 317-688-5500
  • Fax:
Mailing address:
  • Phone: 317-278-0221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number01095488A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: