Healthcare Provider Details

I. General information

NPI: 1659662419
Provider Name (Legal Business Name): MEREDITH JANE POTRZEBOWSKI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 N MAIN ST
LAPEL IN
46051-9671
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 765-534-3127
  • Fax: 765-534-3022
Mailing address:
  • Phone: 317-621-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number73798
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02004072A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: