Provider Demographics
NPI:1578544383
Name:KOLE, AME LANGMACK
Entity Type:Individual
Prefix:
First Name:AME
Middle Name:LANGMACK
Last Name:KOLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AME
Other - Middle Name:LYN
Other - Last Name:LANGMACK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3403 E RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-4744
Mailing Address - Country:US
Mailing Address - Phone:317-957-2000
Mailing Address - Fax:317-957-2050
Practice Address - Street 1:1633 N CAPITOL AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1261
Practice Address - Country:US
Practice Address - Phone:317-962-5014
Practice Address - Fax:317-962-2427
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72000069A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200395800Medicaid