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General NPI Number Information
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NPI Number | 1841841822
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Entity Type | Individual
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Provider Name | ANISA MEGHAN JALLAL PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/22/2019
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 10590 N MERIDIAN ST STE 105
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City | CARMEL
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State | IN
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Zip | 46290-1028
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Country | US
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Telephone | 317-583-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 10590 N MERIDIAN ST STE 105
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City | CARMEL
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State | IN
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Zip | 46290-1028
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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 |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1167615
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 10004387A
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License Number State | IN
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