Provider Demographics
NPI:1619984556
Name:NACE, JEFFREY J (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:J
Last Name:NACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11590 N MERIDIAN STREET
Mailing Address - Street 2:SUITE 410
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6955
Mailing Address - Country:US
Mailing Address - Phone:317-688-5580
Mailing Address - Fax:317-688-5581
Practice Address - Street 1:11590 N MERIDIAN STREET
Practice Address - Street 2:SUITE 410
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6955
Practice Address - Country:US
Practice Address - Phone:317-688-5580
Practice Address - Fax:317-688-5581
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48389207R00000X
IN01063718A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200860850Medicaid
IN200860850Medicaid