Healthcare Provider Details

I. General information

NPI: 1447445614
Provider Name (Legal Business Name): MARY ZELLER STUY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 W WALNUT ST
INDIANAPOLIS IN
46202-5188
US

IV. Provider business mailing address

PO BOX 44994
INDIANAPOLIS IN
46244-0994
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-3966
  • Fax:
Mailing address:
  • Phone: 317-274-4402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01037410A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: