Provider Demographics
NPI:1346515368
Name:STREET, JAMIE S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:S
Last Name:STREET
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4050 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46205-2615
Mailing Address - Country:US
Mailing Address - Phone:317-283-8162
Mailing Address - Fax:317-283-3644
Practice Address - Street 1:4050 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46205-2615
Practice Address - Country:US
Practice Address - Phone:317-283-8162
Practice Address - Fax:317-283-3644
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024994A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology