Healthcare Provider Details

I. General information

NPI: 1902880404
Provider Name (Legal Business Name): JUDITH ANN MONROE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 NAAB RD SUITE 200
INDIANAPOLIS IN
46260-5926
US

IV. Provider business mailing address

9588 VALPARAISO CT
INDIANAPOLIS IN
46268-1130
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-7510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01038379A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: