Provider Demographics
NPI:1588655294
Name:PARDIECK, JANE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:A
Last Name:PARDIECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:ANN PARDIECK
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:113 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2176
Mailing Address - Country:US
Mailing Address - Phone:812-524-8388
Mailing Address - Fax:
Practice Address - Street 1:113 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2176
Practice Address - Country:US
Practice Address - Phone:812-524-8388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031102A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100236270Medicaid
IN000000575566OtherANTHEM
IN000000671398OtherANTHEM