Healthcare Provider Details

I. General information

NPI: 1629019096
Provider Name (Legal Business Name): AURELIA MICAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 HIGH POINT TRL
DYER IN
46311-4602
US

IV. Provider business mailing address

233 HIGH POINT TRL
DYER IN
46311-4602
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-5800
  • Fax:
Mailing address:
  • Phone: 219-836-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01050320A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier200217070
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: