Provider Demographics
NPI:1821039207
Name:DOAK, JOAN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:F
Last Name:DOAK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 N SAMUEL MOORE PKWY
Practice Address - Street 2:STE C
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1467
Practice Address - Country:US
Practice Address - Phone:317-483-5080
Practice Address - Fax:317-483-5085
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2014-01-29
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Provider Licenses
StateLicense IDTaxonomies
IN01032861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100206090Medicaid
INM400017584Medicare PIN
IN100206090Medicaid