Provider Demographics
NPI:1497752844
Name:JANSEN, JON J (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:J
Last Name:JANSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8040 CLEARVISTA PKWY
Practice Address - Street 2:#240
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5630
Practice Address - Country:US
Practice Address - Phone:317-621-5450
Practice Address - Fax:317-621-5453
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042313208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000085876OtherANTHEM
IN000000764306OtherANTHEM
INP01157045OtherMEDICARE RAILROAD
IN020024683OtherMEDICARE RAILROAD
IN100421600Medicaid
IN100421600AMedicaid
IN523730CMedicare PIN
IN000000764306OtherANTHEM
INF81838Medicare UPIN
IN260750DMedicare PIN