Healthcare Provider Details

I. General information

NPI: 1386166577
Provider Name (Legal Business Name): MALESA MARIE PRICE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2017
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N GIRLS SCHOOL RD
INDIANAPOLIS IN
46214-3672
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-957-9020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02006321A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: