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General NPI Number Information
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NPI Number | 1942481965
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Entity Type | Organization
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Legal Business Name | ST. MARY ADULT MEDICINE, LLC
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 09/14/2016
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Provider Practice Location Address
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Address Line | 5525 GEORGETOWN RD STE F
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-3717
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Country | US
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Telephone | 317-293-9039
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Fax | 317-293-9049
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Provider Business Mailing Address
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Address Line | 5525 GEORGETOWN RD SUITE F
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-3717
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Country | US
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Telephone | 317-293-9039
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Fax | 317-293-9049
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Authorized Official
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Title or Position | OWNER
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Name | DR. MALAK G HERMINA
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Credential | MD
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Telephone | 317-293-9039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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