Healthcare Provider Details

I. General information

NPI: 1962473694
Provider Name (Legal Business Name): MARIA LUISA PILAR DEBUQUE ERMITANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8150 OAKLANDON RD
INDIANAPOLIS IN
46236-9525
US

IV. Provider business mailing address

8150 OAKLANDON RD
INDIANAPOLIS IN
46236-9525
US

V. Phone/Fax

Practice location:
  • Phone: 317-826-5440
  • Fax: 317-826-5463
Mailing address:
  • Phone: 317-826-5440
  • Fax: 317-826-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number01061785A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: