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General NPI Number Information
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NPI Number | 1497405419
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Entity Type | Individual
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Provider Name | AMANDA SPAN DO
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Gender | Female
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Dates
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Enumeration Date | 03/24/2022
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 13861 OLIO RD
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City | FISHERS
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State | IN
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Zip | 46037-3487
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Country | US
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Telephone | 317-338-7136
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Fax | 317-338-6359
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Provider Business Mailing Address
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Address Line | 8414 NAAB RD STE 100
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City | INDIANAPOLIS
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State | IN
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Zip | 46260-1972
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Country | US
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Telephone | 317-338-7510
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Fax | 317-338-7539
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 02008532A
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License Number State | IN
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