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NPI Code Detail

MEDICARE: STEPHEN R. MYRON M.D.

MEDICARE: STEPHEN R. MYRON 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
1207Q00000XFamily Medicine Physician01029521AIN
2207P00000XEmergency Medicine Physician0102951AIN

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 : 1801889142
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHEN R. MYRON M.D.
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE STE 200
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number : 317-962-3834
Fax Number :
Provider Business Practice Location Address
First Line : 430 W VOTAW ST
Second Line :
City : PORTLAND
State : IN
Zip : 47371-1302
Country : US
Telephone Number : 260-726-6515
Fax Number : 260-726-2814
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2005
Last Update Date : 03/29/2022

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Directions to “ STEPHEN R. MYRON M.D.” Practice Location

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