Provider Demographics
NPI:1558597807
Name:AMDE, SEWIT (MD)
Entity Type:Individual
Prefix:DR
First Name:SEWIT
Middle Name:
Last Name:AMDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E BOYD AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-2816
Mailing Address - Country:US
Mailing Address - Phone:317-462-5252
Mailing Address - Fax:317-462-8010
Practice Address - Street 1:300 E BOYD AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-2816
Practice Address - Country:US
Practice Address - Phone:317-462-5252
Practice Address - Fax:317-462-8010
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-01
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068294A208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200988480Medicaid
INM400021171Medicare PIN