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General NPI Number Information
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NPI Number | 1245287101
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Entity Type | Individual
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Provider Name | STACEY ISHMAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 8402 HARCOURT RD STE 400
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-2053
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Country | US
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Telephone | 317-338-6815
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 933432
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City | CLEVELAND
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State | OH
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Zip | 44193-0039
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Country | US
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Telephone | 937-641-5072
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Fax | 937-641-6129
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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 | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | 35.121930
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207YS0012X
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Taxonomy Name | Sleep Medicine (Otolaryngology) Physician
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License Number | 35.121930
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | 01088233A
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License Number State | IN
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