Healthcare Provider Details

I. General information

NPI: 1972980738
Provider Name (Legal Business Name): PAUL T PARACKAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date: 12/09/2015
Reactivation Date: 08/24/2016

III. Provider practice location address

2040 N SHADELAND AVE STE 200
INDIANAPOLIS IN
46219-1727
US

IV. Provider business mailing address

2040 N SHADELAND AVE STE 200
INDIANAPOLIS IN
46219-1727
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-1800
  • Fax: 317-355-1803
Mailing address:
  • Phone: 317-355-1800
  • Fax: 317-355-1803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number01083312A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: