Healthcare Provider Details

I. General information

NPI: 1023061967
Provider Name (Legal Business Name): JUDITH M BEALKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 BARNHILL DR RM. 4300
INDIANAPOLIS IN
46202-5128
US

IV. Provider business mailing address

550 N MERIDIAN ST STE 114
INDIANAPOLIS IN
46204-1207
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-8162
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01042937
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: