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General NPI Number Information
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NPI Number | 1184447740
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Entity Type | Individual
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Provider Name | MICHELLE WIEBKE
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Gender | Female
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Dates
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Enumeration Date | 11/04/2024
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Last Update Date | 11/04/2024
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Provider Practice Location Address
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Address Line | 5110 COMMERCE SQUARE DR STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-9244
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Country | US
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Telephone | 317-526-4731
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Fax |
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Provider Business Mailing Address
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Address Line | 5110 COMMERCE SQUARE DR STE A
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-9244
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 10672
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 23002844A
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License Number State | IN
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