Healthcare Provider Details

I. General information

NPI: 1083678585
Provider Name (Legal Business Name): JASON CHAD EHRET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 11/27/2023
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 CLEARVISTA DRIVE STE 227
INDIANAPOLIS IN
46256-5600
US

IV. Provider business mailing address

6626 E 75TH STREET STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-5719
  • Fax: 317-621-6086
Mailing address:
  • Phone: 317-621-7561
  • Fax: 317-355-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01060267A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: