Provider Demographics
NPI:1083102206
Name:MERIWEATHER, ALEXIS DANIELLE (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:DANIELLE
Last Name:MERIWEATHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 ESKENAZI AVENUE
Practice Address - Street 2:FIFTH THIRD BANK BUILDING 3RD FLOOR
Practice Address - City:INDIANPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-880-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1083102206207P00000X
IN390200000X
IN01084277A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200369460FMedicaid
IN300014445Medicaid
IN264430A002OtherMEDICARE PTAN
INM120064007OtherMEDICARE PTAN