Provider Demographics
NPI:1275599540
Name:TAVEL, MORTON E (MD)
Entity Type:Individual
Prefix:
First Name:MORTON
Middle Name:E
Last Name:TAVEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 NAAB RD
Mailing Address - Street 2:STE. 400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5924
Mailing Address - Country:US
Mailing Address - Phone:317-338-6666
Mailing Address - Fax:317-338-6066
Practice Address - Street 1:8333 NAAB RD
Practice Address - Street 2:STE. 400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5924
Practice Address - Country:US
Practice Address - Phone:317-338-6666
Practice Address - Fax:317-338-6066
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01018117A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100340910Medicaid
IN898190KMedicare ID - Type Unspecified
IN100340910Medicaid
INM400015117Medicare PIN