Healthcare Provider Details

I. General information

NPI: 1477547222
Provider Name (Legal Business Name): JOHN T MAIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7340 SHADELAND STATION SUITE 200
INDIANAPOLIS IN
46256-3980
US

IV. Provider business mailing address

7340 SHADELAND STATION SUITE 200
INDIANAPOLIS IN
46256-3980
US

V. Phone/Fax

Practice location:
  • Phone: 317-579-2150
  • Fax: 317-579-2130
Mailing address:
  • Phone: 317-579-2150
  • Fax: 317-579-2130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1031153
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01031153A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number01031153A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: