MEDICARE: DR. MICHAEL J DEAL M.D.

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	2084P0800X	Psychiatry Physician	01024942A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	115484491	OTHER	IN	UNITED BEHAVIORAL HEALTH
2	4363541	OTHER	IN	AETNA
3	061394000	OTHER	IN	MAGELLAN
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	11348152	OTHER	IN	CAQH

General Provider Information

NPI Number	:	1285632992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL J DEAL M.D.

Provider Business Mailing Address
First Line	:	8122 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6076
Country	:	US
Telephone Number	:	317-884-1752
Fax Number	:	317-884-1753

Provider Business Practice Location Address
First Line	:	8122 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6076
Country	:	US
Telephone Number	:	317-884-1752
Fax Number	:	317-884-1753

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

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	02/22/2017

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