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NPI Code Detail

MEDICARE: MR. MATTHEW DAVID MOELLER

MEDICARE: MR. MATTHEW DAVID MOELLER
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
1363L00000XNurse Practitioner71017118AIN

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 : 1790661411
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MATTHEW DAVID MOELLER
Provider Business Mailing Address
First Line : 6626 E 75TH ST STE 500
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-2890
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7150 CLEARVISTA DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-1695
Country : US
Telephone Number : 317-621-8000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/15/2025
Last Update Date : 01/22/2026

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Directions to “ MR. MATTHEW DAVID MOELLER ” Practice Location

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