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General NPI Number Information
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NPI Number | 1316191190
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Entity Type | Organization
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Legal Business Name | MERIDIAN PEDIATRICS
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Dates
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Enumeration Date | 11/06/2008
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Last Update Date | 11/06/2008
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Provider Practice Location Address
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Address Line | 12065 OLD MERIDIAN ST SUITE 100
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City | CARMEL
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State | IN
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Zip | 46032-8773
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Country | US
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Telephone | 317-844-5351
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Fax |
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Provider Business Mailing Address
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Address Line | 12065 OLD MERIDIAN ST SUITE 100
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City | CARMEL
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State | IN
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Zip | 46032-8773
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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 | PHYSICIAN
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Name | JILL MAUZREK
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Credential | M.D.
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Telephone | 317-844-5351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01043902
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License Number State | IN
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