Healthcare Provider Details

I. General information

NPI: 1275068124
Provider Name (Legal Business Name): AMALIA SUE GRIFFIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMALIA SUE LEHMANN M.D.

II. Dates (important events)

Enumeration Date: 04/28/2017
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7150 CLEARVISTA DR
INDIANAPOLIS IN
46256-1695
US

IV. Provider business mailing address

PO BOX 1026
INDIANAPOLIS IN
46206-1026
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-6262
  • Fax:
Mailing address:
  • Phone: 317-777-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01083751A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: