Healthcare Provider Details

I. General information

NPI: 1598424095
Provider Name (Legal Business Name): JUNOT BADETTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8063 MADISON AVE
INDIANAPOLIS IN
46227-6001
US

IV. Provider business mailing address

PO BOX 19332
WEST PALM BEACH FL
33416-9332
US

V. Phone/Fax

Practice location:
  • Phone: 917-436-7053
  • Fax:
Mailing address:
  • Phone: 917-436-7053
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number10005251A-P.A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: