MEDICARE: NICOLE SUZETTE PERRY 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
1	207V00000X	Obstetrics & Gynecology Physician	01040509A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P01018478	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000283023	OTHER	IN	ANTHEM PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801899901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE SUZETTE PERRY M.D.

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	:	100 TOWN CENTER RD S
Second Line	:	STE B
City	:	MOORESVILLE
State	:	IN
Zip	:	46158-2321
Country	:	US
Telephone Number	:	317-497-2300
Fax Number	:	317-497-2502

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	11/27/2023

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Directions to “ NICOLE SUZETTE PERRY M.D.” Practice Location

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