Healthcare Provider Details

I. General information

NPI: 1164807178
Provider Name (Legal Business Name): MICHAEL PAINTER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 E MARKET ST
CLOVERDALE IN
46120-8427
US

IV. Provider business mailing address

1542 S BLOOMINGTON ST
GREENCASTLE IN
46135-2297
US

V. Phone/Fax

Practice location:
  • Phone: 765-795-4242
  • Fax: 765-217-2100
Mailing address:
  • Phone: 765-301-7300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28181189A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71005703A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71005703A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: