MEDICARE: DR. JOHN MARK MICHAEL M.D.

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	207W00000X	Ophthalmology Physician	01033505	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180007434	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	:	1578567426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN MARK MICHAEL M.D.

Provider Business Mailing Address
First Line	:	242 WILLOWGATE LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1431
Country	:	US
Telephone Number	:	317-848-1611
Fax Number	:

Provider Business Practice Location Address
First Line	:	242 WILLOWGATE LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1431
Country	:	US
Telephone Number	:	317-848-1611
Fax Number	:

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	03/04/2016

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