Healthcare Provider Details

I. General information

NPI: 1891920914
Provider Name (Legal Business Name): ANNE CAROLINE KITCHENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2009
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8435 CLEARVISTA PL STE 101
INDIANAPOLIS IN
46256
US

IV. Provider business mailing address

6626 E 75TH ST STE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-1006
  • Fax: 317-355-6822
Mailing address:
  • Phone: 317-621-1647
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11014777A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number01071351A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: