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General NPI Number Information
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NPI Number | 1346489630
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Entity Type | Individual
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Provider Name | MICHAEL CHRISTOPHER LARGE M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/11/2009
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 14300 E 138TH STE A
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City | FISHERS
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State | IN
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Zip | 46037-0087
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Country | US
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Telephone | 317-813-1660
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Fax | 317-813-1667
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Provider Business Mailing Address
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Address Line | 679 E COUNTY LINE RD
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City | GREENWOOD
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State | IN
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Zip | 46143-1049
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Country | US
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Telephone | 317-885-1250
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Fax | 317-859-4268
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 125-049267
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 01072896A
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License Number State | IN
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