Healthcare Provider Details

I. General information

NPI: 1679730261
Provider Name (Legal Business Name): MARTIN HENRY PLAWECKI M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2008
Last Update Date: 06/15/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 WISHARD BLVD. SUITE 4110
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

250 N SHADELAND AVE STE 200
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-944-8162
  • Fax: 317-948-0609
Mailing address:
  • Phone: 317-962-3834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01066651A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01066651A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: