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NPI Code Detail

MEDICARE: MATTHEW MAHLER

MEDICARE:   MATTHEW  MAHLER
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
1183500000XPharmacist26023659AIN

General Provider Information

NPI Number : 1073169629
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW MAHLER
Provider Business Mailing Address
First Line : 3253 FRANKLIN ST
Second Line :
City : MICHIGAN CITY
State : IN
Zip : 46360-7005
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3253 FRANKLIN ST
Second Line :
City : MICHIGAN CITY
State : IN
Zip : 46360-7005
Country : US
Telephone Number : 219-872-5854
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2019
Last Update Date : 08/09/2019

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Directions to “ MATTHEW MAHLER ” Practice Location

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