Healthcare Provider Details

I. General information

NPI: 1669874111
Provider Name (Legal Business Name): KAITLIN ROTHSCHILD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAITLIN CARR PA-C

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N RITTER AVE
INDIANAPOLIS IN
46219-3027
US

IV. Provider business mailing address

6626 E 75TH ST
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-5041
  • Fax:
Mailing address:
  • Phone: 317-621-7547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001735A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: