Healthcare Provider Details

I. General information

NPI: 1316109598
Provider Name (Legal Business Name): KERRY MARIE HEGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KERRY M FITZPATRICK

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 11/15/2022
Certification Date: 11/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR ROC 4340
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

PO BOX 1026
INDIANAPOLIS IN
46206-1026
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-2143
  • Fax: 317-944-3107
Mailing address:
  • Phone: 317-274-1201
  • Fax: 317-278-9905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number01069882
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: