Healthcare Provider Details

I. General information

NPI: 1124001722
Provider Name (Legal Business Name): DIANE WEISMAN HEALEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8424 NAAB RD STE 1L
INDIANAPOLIS IN
46260-1954
US

IV. Provider business mailing address

8424 NAAB RD STE 1L
INDIANAPOLIS IN
46260-1954
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-7780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number01032796A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: