Provider Demographics
NPI:1083725790
Name:TEMPEL, MARY J (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:TEMPEL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3755 E 82ND ST
Mailing Address - Street 2:#75
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-7335
Mailing Address - Country:US
Mailing Address - Phone:317-926-3739
Mailing Address - Fax:317-921-7478
Practice Address - Street 1:11900 N PENNSYLVANIA ST
Practice Address - Street 2:#202
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4693
Practice Address - Country:US
Practice Address - Phone:317-926-3739
Practice Address - Fax:317-921-7478
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN28050560A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200253470AMedicaid
IN061500MMedicare ID - Type UnspecifiedMEDICARE ID
IN200253470AMedicaid