Provider Demographics
NPI:1477547222
Name:MAIL, JOHN T (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:T
Last Name:MAIL
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 1:7340 SHADELAND STATION
Mailing Address - Street 2:SUITE 200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3980
Mailing Address - Country:US
Mailing Address - Phone:317-579-2150
Mailing Address - Fax:317-579-2130
Practice Address - Street 1:7340 SHADELAND STATION
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3980
Practice Address - Country:US
Practice Address - Phone:317-579-2150
Practice Address - Fax:317-579-2130
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10311532085R0202X
IN01031153A2085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300027985OtherRAILROAD MEDICARE
P00019664OtherRAILROAD MEDICARE
P00019939OtherRAILROAD MEDICARE
P00023641OtherRAILROAD MEDICARE
IN000000109956OtherANTHEM
IN100320690AMedicaid
P00018790OtherRAILROAD MEDICARE
P00019661OtherRAILROAD MEDICARE
P00019663OtherRAILROAD MEDICARE
P00021356OtherRAILROAD MEDICARE
P00019829OtherRAILROAD MEDICARE
P00019938OtherRAILROAD MEDICARE
P00018788OtherRAILROAD MEDICARE
P00023438OtherRAILROAD MEDICARE
151560DDMedicare PIN
P00018788OtherRAILROAD MEDICARE
P00019938OtherRAILROAD MEDICARE
P00019829OtherRAILROAD MEDICARE
152410EEMedicare PIN
P00019664OtherRAILROAD MEDICARE
151700PPMedicare PIN