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NPI Code Detail

MEDICARE: DR. MARY D ROUSE MD

MEDICARE: DR. MARY D ROUSE 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
12080A0000XPediatric Adolescent Medicine Physician01040728IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578509345
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARY D ROUSE MD
Provider Business Mailing Address
First Line : 6640 INTECH BLVD
Second Line : STE 195
City : INDIANAPOLIS
State : IN
Zip : 46278-2011
Country : US
Telephone Number : 317-295-0608
Fax Number : 317-295-0622
Provider Business Practice Location Address
First Line : 6640 INTECH BLVD
Second Line : SUITE 195
City : INDIANAPOLIS
State : IN
Zip : 46278-2011
Country : US
Telephone Number : 317-295-0608
Fax Number : 317-295-0622
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2006
Last Update Date : 12/01/2014

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Directions to “ DR. MARY D ROUSE MD” Practice Location

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