Provider Demographics
NPI:1508011008
Name:JON D MARHENKE MD INC
Entity Type:Organization
Organization Name:JON D MARHENKE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARHENKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-578-5344
Mailing Address - Street 1:6515 E. 82ND STREET
Mailing Address - Street 2:#207
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1544
Mailing Address - Country:US
Mailing Address - Phone:317-578-5344
Mailing Address - Fax:317-578-5345
Practice Address - Street 1:6515 E. 82ND STREET
Practice Address - Street 2:#207
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-1544
Practice Address - Country:US
Practice Address - Phone:317-578-5344
Practice Address - Fax:317-578-5345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01022803A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty