MEDICARE: JUDIANN MISKULIN 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	208600000X	Surgery Physician	01061067A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01824517	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000386158	OTHER	IN	ANTHEM PIN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790742450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDIANN MISKULIN MD

Provider Business Mailing Address
First Line	:	757 MASSACHUSETTS AVE UNIT 402
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-1692
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	757 MASSACHUSETTS AVE UNIT 402
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46204-1692
Country	:	US
Telephone Number	:	317-000-0000
Fax Number	:

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	11/01/2023

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Directions to “ JUDIANN MISKULIN MD” Practice Location

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