Provider Demographics
NPI:1407606395
Name:MOUSSIGNAC ANTOINE, MICHELENE
Entity Type:Individual
Prefix:
First Name:MICHELENE
Middle Name:
Last Name:MOUSSIGNAC ANTOINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4838 SUNPOINT CIR APT 604
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-4602
Mailing Address - Country:US
Mailing Address - Phone:619-847-1139
Mailing Address - Fax:
Practice Address - Street 1:4838 SUNPOINT CIR APT 604
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-4602
Practice Address - Country:US
Practice Address - Phone:619-847-1139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171R00000XOther Service ProvidersInterpreterGroup - Single Specialty