MEDICARE: MICHELLE A HANZELY PA-C

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	363A00000X	Physician Assistant	085001934	IL
2	363AM0700X	Medical Physician Assistant	10001772A	IN
3	363A00000X	Physician Assistant	10001772A	IN
4	363A00000X	Physician Assistant	10001772B	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811192362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE A HANZELY PA-C

Provider Business Mailing Address
First Line	:	10330 N MERIDIAN ST # 300
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1024
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9240 N MERIDIAN ST STE 160
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1827
Country	:	US
Telephone Number	:	317-574-2286
Fax Number	:

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

Provider Enumeration Date	:	06/15/2007
Last Update Date	:	10/04/2016

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Directions to “ MICHELLE A HANZELY PA-C” Practice Location

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