MEDICARE: DR. AMANDA LYNN BORN 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	207V00000X	Obstetrics & Gynecology Physician	01073049A	IN

General Provider Information

NPI Number	:	1881822534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMANDA LYNN BORN MD

Provider Business Mailing Address
First Line	:	13420 N MERIDIAN ST STE 300
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-1581
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13420 N MERIDIAN ST #300
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-7102
Country	:	US
Telephone Number	:	317-582-9500
Fax Number	:

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

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	06/01/2022

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