Healthcare Provider Details

I. General information

NPI: 1083872303
Provider Name (Legal Business Name): MICHELLE R LAUGHLIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE R BRAUN MD

II. Dates (important events)

Enumeration Date: 05/23/2008
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5166
US

IV. Provider business mailing address

250 N SHADELAND AVE SUITE 130, PROVIDER ENROLLMENT
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-5049
  • Fax:
Mailing address:
  • Phone: 317-963-0860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number11013768A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01072526A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: