MEDICARE: STEPHEN J. MASSICOTTE, M.D., P.C.

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	207W00000X	Ophthalmology Physician	01039382A	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	:	1043353907
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEPHEN J. MASSICOTTE, M.D., P.C.

Provider Business Mailing Address
First Line	:	3955 EAGLE CREEK PKWY
Second Line	:	SUITE C
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5615
Country	:	US
Telephone Number	:	317-280-8410
Fax Number	:	317-280-8414

Provider Business Practice Location Address
First Line	:	3955 EAGLE CREEK PKWY
Second Line	:	SUITE C
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46254-5615
Country	:	US
Telephone Number	:	317-280-8410
Fax Number	:	317-280-8414

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. STEPHEN JOHN MASSICOTTE
Credential	:	M.D.
Telephone Number	:	317-280-8410

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/26/2014

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