Healthcare Provider Details

I. General information

NPI: 1306467048
Provider Name (Legal Business Name): MY MOBILE MD ROUNDING PROVIDERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 E VERMONT ST STE 110
INDIANAPOLIS IN
46202-3685
US

IV. Provider business mailing address

PO BOX 586
GALLOWAY OH
43119-0586
US

V. Phone/Fax

Practice location:
  • Phone: 317-559-0950
  • Fax: 317-936-3028
Mailing address:
  • Phone: 765-969-7841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: STEVE MARTIN
Title or Position: CEO
Credential:
Phone: 317-670-6635