MEDICARE: TRICIA HERN 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	207Q00000X	Family Medicine Physician	036-104483	IL
2	207Q00000X	Family Medicine Physician	01064913A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01291571	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1427087170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRICIA HERN MD

Provider Business Mailing Address
First Line	:	6626 E 75TH ST
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10122 E 10TH ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46229-2663
Country	:	US
Telephone Number	:	317-355-5717
Fax Number	:	317-898-9760

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	06/09/2021

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Directions to “ TRICIA HERN MD” Practice Location

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