Provider Demographics
NPI:1881199487
Name:SUMMAY, JERILYN MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:JERILYN
Middle Name:MICHELLE
Last Name:SUMMAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JERILYN
Other - Middle Name:MICHELLE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:705 RILEY HOSPITAL DR.
Mailing Address - Street 2:RI 5837
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202
Mailing Address - Country:US
Mailing Address - Phone:317-944-4034
Mailing Address - Fax:
Practice Address - Street 1:705 RILEY HOSPITAL DR.
Practice Address - Street 2:RI-5837
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-944-4304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-26
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program