Healthcare Provider Details

I. General information

NPI: 1194819714
Provider Name (Legal Business Name): ROBERT PETER MOHLMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 NORTH TIBBS AVENUE
INDIANAPOLIS IN
46222
US

IV. Provider business mailing address

PO BOX 26456
INDIANAPOLIS IN
46226
US

V. Phone/Fax

Practice location:
  • Phone: 317-630-5215
  • Fax: 317-630-5221
Mailing address:
  • Phone: 317-524-6360
  • Fax: 317-544-4355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01023370A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: