MEDICARE: MARK ROLLINS D.O.

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	207Q00000X	Family Medicine Physician	01056301A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000548671	OTHER		BLUE CROSS INDIANA
2	01056301	OTHER	IN	STATE LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598746240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ROLLINS D.O.

Provider Business Mailing Address
First Line	:	6626 E 75TH ST
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1011 MAIN STREET
Second Line	:	SUITE 140
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-6970
Country	:	US
Telephone Number	:	317-957-9000
Fax Number	:

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	11/27/2023

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Directions to “ MARK ROLLINS D.O.” Practice Location

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