Healthcare Provider Details

I. General information

NPI: 1932307527
Provider Name (Legal Business Name): MARIA E FAGET MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/12/2024
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 INTELLIPLEX DR STE 230
SHELBYVILLE IN
46176-8581
US

IV. Provider business mailing address

30 W RAMPART ST STE 200
SHELBYVILLE IN
46176-8846
US

V. Phone/Fax

Practice location:
  • Phone: 317-398-0193
  • Fax: 317-398-0727
Mailing address:
  • Phone: 317-421-2012
  • Fax: 317-398-1851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01072028A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: