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General NPI Number Information
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NPI Number | 1730663923
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Entity Type | Organization
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Legal Business Name | MAOAC, LLC
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Dates
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Enumeration Date | 09/24/2018
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Last Update Date | 09/24/2018
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Provider Practice Location Address
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Address Line | 8856 SOUTH ST
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City | FISHERS
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State | IN
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Zip | 46038-2911
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Country | US
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Telephone | 317-516-1177
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Fax | 317-516-5128
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Provider Business Mailing Address
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Address Line | 8856 SOUTH ST
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City | FISHERS
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State | IN
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Zip | 46038-2911
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Country | US
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Telephone | 317-516-1177
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Fax | 317-516-5128
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CASSY BRATCHER
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Credential |
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Telephone | 317-213-6762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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