MEDICARE: MR. CHRISTOPHER WAYNE DIETRICH PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	10000684A	IN

General Provider Information

NPI Number	:	1013967462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRISTOPHER WAYNE DIETRICH PA

Provider Business Mailing Address
First Line	:	8333 NAAB RD
Second Line	:	SUITE 250
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5924
Country	:	US
Telephone Number	:	317-396-1300
Fax Number	:	317-396-1346

Provider Business Practice Location Address
First Line	:	8333 NAAB RD
Second Line	:	SUITE 250
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5924
Country	:	US
Telephone Number	:	317-396-1300
Fax Number	:	317-396-1346

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	06/10/2013

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