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NPI Code Detail

MEDICARE: MR. EVAN THAYER MD

MEDICARE: MR. EVAN THAYER 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
1207L00000XAnesthesiology Physician01081973BIN
2390200000XStudent in an Organized Health Care Education/Training Program
3207L00000XAnesthesiology Physician01081973AIN

General Provider Information

NPI Number : 1508210063
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EVAN THAYER MD
Provider Business Mailing Address
First Line : 10330 N MERIDIAN ST STE 201
Second Line :
City : CARMEL
State : IN
Zip : 46290-1024
Country : US
Telephone Number : 317-338-6234
Fax Number :
Provider Business Practice Location Address
First Line : 10330 N MERIDIAN ST STE 201
Second Line :
City : CARMEL
State : IN
Zip : 46290-1024
Country : US
Telephone Number : 317-338-6234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2016
Last Update Date : 06/30/2021

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