MEDICARE: DR. JULIE A VANNERSON 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
1	207R00000X	Internal Medicine Physician	01064152A	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1598721953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE A VANNERSON MD

Provider Business Mailing Address
First Line	:	8910 PURDUE RD
Second Line	:	STE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46268-3161
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 WISHARD BLVD
Second Line	:	PCC 4TH FLOOR
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2872
Country	:	US
Telephone Number	:	317-692-2323
Fax Number	:	317-656-3967

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	08/19/2011

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