Healthcare Provider Details

I. General information

NPI: 1487975637
Provider Name (Legal Business Name): MICHELE K PEGGS-MINEART M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELE K PEGGS M.D.

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N SENATE AVE EMERGENCY MEDICINE ROOM B401
INDIANAPOLIS IN
46202-5306
US

IV. Provider business mailing address

1012 SUNSHINE CT
WESTFIELD IN
46074-7744
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-5975
  • Fax:
Mailing address:
  • Phone: 316-641-7593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number01071926A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01071926A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: