MEDICARE: DOUGLAS MAXWELL MD

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	207RN0300X	Nephrology Physician	01022037A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043205800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS MAXWELL MD

Provider Business Mailing Address
First Line	:	8935 N MERIDIAN ST
Second Line	:	SUITE 200
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5379
Country	:	US
Telephone Number	:	317-564-2132
Fax Number	:	317-574-4737

Provider Business Practice Location Address
First Line	:	1350 E COUNTY LINE RD
Second Line	:	SUITE L
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-0873
Country	:	US
Telephone Number	:	317-865-8530
Fax Number	:	317-865-8539

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	07/22/2008

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Directions to “ DOUGLAS MAXWELL MD” Practice Location

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