Provider Demographics
NPI:1497746895
Name:GIROD, JUSTINA M (MD)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:M
Last Name:GIROD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUSTINA
Other - Middle Name:
Other - Last Name:KROUSE
Other - Suffix:
Other - Last Name Type:Former Name
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 1:1809 S MAIN ST
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:IN
Practice Address - Zip Code:46989-9257
Practice Address - Country:US
Practice Address - Phone:765-770-0650
Practice Address - Fax:765-770-0652
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058149A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM12240461OtherMEDICARE PTAN
000000359608OtherBLUE CROSS BLUE SHIELD
INP00967448OtherRAILROAD MEDICARE
IN200475910Medicaid
H98634Medicare UPIN
000000031547OtherMPLAN
000000359608OtherBLUE CROSS BLUE SHIELD
IN200475910Medicaid
IN925500IIMedicare PIN