Healthcare Provider Details

I. General information

NPI: 1235424011
Provider Name (Legal Business Name): JAMES MALOY HOTZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 10/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-1772
  • Fax: 317-988-5385
Mailing address:
  • Phone: 317-988-1772
  • Fax: 317-988-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01073938A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: