Provider Demographics
NPI:1922444785
Name:LAND, TARA K (DO)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:K
Last Name:LAND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:K
Other - Last Name:SCHULTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8890 E 116TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2856
Practice Address - Country:US
Practice Address - Phone:317-621-1500
Practice Address - Fax:317-621-1509
Is Sole Proprietor?:No
Enumeration Date:2013-05-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN02004582A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201171390Medicaid
INP01723966OtherRR MEDICARE
IN201171390Medicaid