Healthcare Provider Details

I. General information

NPI: 1922006949
Provider Name (Legal Business Name): MARVIN E VOLLMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 CLEARVISTA PKWY SUITE 330
INDIANAPOLIS IN
46256
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-2212
  • Fax: 317-621-2215
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number01029568A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number01029568A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: