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NPI Code Detail

MEDICARE: MARY JO STINE M.D.

MEDICARE: MARY JO STINE 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
12080N0001XNeonatal-Perinatal Medicine Physician01029565AIN
2208000000XPediatrics Physician01029565AIN

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 : 1619965803
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY JO STINE M.D.
Provider Business Mailing Address
First Line : 8003 CASTLEWAY DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-1946
Country : US
Telephone Number : 317-576-1335
Fax Number : 844-397-1311
Provider Business Practice Location Address
First Line : 35 BOB BABBS DR
Second Line :
City : SPENCER
State : IN
Zip : 47460-6828
Country : US
Telephone Number : 812-665-1700
Fax Number : 844-605-9160
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/11/2005
Last Update Date : 01/24/2023

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