Provider Demographics
NPI:1487659835
Name:HUSE, JOHN M (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:HUSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13430 N MERIDIAN ST
Mailing Address - Street 2:SUITE 275
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1405
Mailing Address - Country:US
Mailing Address - Phone:317-582-8815
Mailing Address - Fax:317-582-8825
Practice Address - Street 1:13430 N MERIDIAN ST
Practice Address - Street 2:SUITE 275
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1405
Practice Address - Country:US
Practice Address - Phone:317-582-8815
Practice Address - Fax:317-582-8825
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2011-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01024414A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100059800AMedicaid
INHU071360Medicare ID - Type Unspecified
C24303Medicare UPIN