Healthcare Provider Details

I. General information

NPI: 1780242578
Provider Name (Legal Business Name): CHARLES MACIAS JR. HAD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2019
Last Update Date: 06/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 IRONWOOD DR STE A
FRANKLIN IN
46131-8324
US

IV. Provider business mailing address

8650 VALLEY LAKE CT
INDIANAPOLIS IN
46227-6925
US

V. Phone/Fax

Practice location:
  • Phone: 317-668-3145
  • Fax:
Mailing address:
  • Phone: 317-590-4151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001526A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: