Provider Demographics
NPI:1346290921
Name:RAWLS, PAULA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:JEAN
Last Name:RAWLS
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 1:11700 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-4656
Practice Address - Country:US
Practice Address - Phone:317-577-4200
Practice Address - Fax:317-577-9503
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16165207L00000X
IN01065754A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200929350Medicaid
IN264430H44OtherMEDICARE PTAN
IN300077748Medicaid
603138200OtherDOL INDIV #
OK200008120AMedicaid
731451967001OtherBCBS GRP BILLING #
IN000000600094OtherANTHEM PROVIDER NUMBER
603138200OtherDOL INDIV #
050058575Medicare PIN