Healthcare Provider Details

I. General information

NPI: 1659557007
Provider Name (Legal Business Name): FREDRICK ALLEN MAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 04/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 MOON SHADOW LN
INDIANAPOLIS IN
46280-1733
US

IV. Provider business mailing address

2235 MOON SHADOW LN
INDIANAPOLIS IN
46280-1733
US

V. Phone/Fax

Practice location:
  • Phone: 601-672-3543
  • Fax:
Mailing address:
  • Phone: 601-672-3543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01027820A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: