Healthcare Provider Details

I. General information

NPI: 1548254451
Provider Name (Legal Business Name): MARY KAY TURNER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 11/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N SENATE BLVD STE 740
INDIANAPOLIS IN
46202-1228
US

IV. Provider business mailing address

1801 N SENATE BLVD STE 740
INDIANAPOLIS IN
46202-1228
US

V. Phone/Fax

Practice location:
  • Phone: 317-962-6262
  • Fax: 317-962-5783
Mailing address:
  • Phone: 317-962-6262
  • Fax: 317-962-5783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01036834
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: