MEDICARE: MALKAH BIRD EDS

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	103TS0200X	School Psychologist	10292696	IN

General Provider Information

NPI Number	:	1477370955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALKAH BIRD EDS

Provider Business Mailing Address
First Line	:	6054 GARVER RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-1517
Country	:	US
Telephone Number	:	248-797-8258
Fax Number	:

Provider Business Practice Location Address
First Line	:	6054 GARVER RD
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-1517
Country	:	US
Telephone Number	:	248-797-8258
Fax Number	:

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

Provider Enumeration Date	:	09/25/2024
Last Update Date	:	09/25/2024

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