MEDICARE: MAYA VOTAPEK

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1518773290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA VOTAPEK

Provider Business Mailing Address
First Line	:	1301 CHIMES BLVD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-3549
Country	:	US
Telephone Number	:	317-658-0441
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 CHIMES BLVD
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46615-3549
Country	:	US
Telephone Number	:	317-658-0441
Fax Number	:

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

Provider Enumeration Date	:	12/06/2024
Last Update Date	:	12/06/2024

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Directions to “ MAYA VOTAPEK ” Practice Location

Language	Start Address	Practice Location

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