Healthcare Provider Details

I. General information

NPI: 1659312387
Provider Name (Legal Business Name): MARYJEAN VORWALD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 W OAK ST STE 104
ZIONSVILLE IN
46077-3835
US

IV. Provider business mailing address

950 N MERIDIAN ST STE 500
INDIANAPOLIS IN
46204-3908
US

V. Phone/Fax

Practice location:
  • Phone: 317-873-8910
  • Fax: 317-873-8821
Mailing address:
  • Phone: 317-962-4945
  • Fax: 317-962-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01035258
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: