Provider Demographics
NPI:1760464374
Name:SQUIRES, MADALYN K (MD)
Entity Type:Individual
Prefix:DR
First Name:MADALYN
Middle Name:K
Last Name:SQUIRES
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 1:8091 TOWNSHIP LINE RD STE 206
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2495
Mailing Address - Country:US
Mailing Address - Phone:317-415-1000
Mailing Address - Fax:317-415-1010
Practice Address - Street 1:8091 TOWNSHIP LINE RD STE 206
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2495
Practice Address - Country:US
Practice Address - Phone:317-415-1000
Practice Address - Fax:317-415-1010
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01030270A207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100382060Medicaid
IN677690XMedicare PIN
IND94547Medicare UPIN
IN100382060Medicaid
IN160020852Medicare PIN