Provider Demographics
NPI:1275536203
Name:JANSEN, NOEL L (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:L
Last Name:JANSEN
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 1:1815 N CAPITOL AVE
Mailing Address - Street 2:STE 405
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1465
Mailing Address - Country:US
Mailing Address - Phone:317-925-3533
Mailing Address - Fax:317-924-5624
Practice Address - Street 1:1815 N CAPITOL AVE
Practice Address - Street 2:STE 405
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1465
Practice Address - Country:US
Practice Address - Phone:317-925-3533
Practice Address - Fax:317-924-5624
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000082148OtherANTHEM PROVIDER NUMBER
IN066350BMedicare ID - Type UnspecifiedMEDICARE NUMBER
IN000000082148OtherANTHEM PROVIDER NUMBER