Provider Demographics
NPI:1346217122
Name:KNOWLES, JUDI ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDI
Middle Name:ANN
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUDI
Other - Middle Name:ANN
Other - Last Name:KNOWLES-DUNCAN
Other - Suffix:
Other - Last Name Type:Other Name
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 1:950 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1077
Practice Address - Country:US
Practice Address - Phone:317-963-2200
Practice Address - Fax:317-963-1621
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN010428112084N0400X
IN01042811A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100381840Medicaid
IN945920AAAMedicare PIN
IN100381840Medicaid
IN798900JMedicare PIN