| St. Mary Adult Medicine, Llc | |
|
5525 Georgetown Rd Ste F Indianapolis IN 46254-3717 | |
| (317) 293-9039 | |
| (317) 293-9049 |
| Full Name | St. Mary Adult Medicine, Llc |
|---|---|
| Speciality | General Practice |
| Location | 5525 Georgetown Rd Ste F, Indianapolis, Indiana |
| Authorized Official Name and Position | Malak G Hermina (OWNER) |
| Authorized Official Contact | 3172939039 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| St. Mary Adult Medicine, Llc 5525 Georgetown Rd Suite F Indianapolis IN 46254-3717 Ph: (317) 293-9039 | St. Mary Adult Medicine, Llc 5525 Georgetown Rd Ste F Indianapolis IN 46254-3717 Ph: (317) 293-9039 |
| NPI Number | 1942481965 |
|---|---|
| Provider Enumeration Date | 11/19/2007 |
| Last Update Date | 09/14/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942481965 | NPI | - | NPPES |
| 201378550 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
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