Healthcare Provider Details

I. General information

NPI: 1932859592
Provider Name (Legal Business Name): TERESA ANNYA PALKOWSKI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 07/25/2026
Certification Date: 07/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 W MICHIGAN ST
INDIANAPOLIS IN
46202-5209
US

IV. Provider business mailing address

1130 W MICHIGAN ST
INDIANAPOLIS IN
46202-5209
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-2018
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number01100091A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: