Provider Demographics
NPI:1942229356
Name:ESTES, MARC J (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:J
Last Name:ESTES
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:
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 1:1300 S JACKSON ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-3313
Practice Address - Country:US
Practice Address - Phone:765-656-3000
Practice Address - Fax:317-968-1321
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2022-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01052384207P00000X
IN01052384A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000365250OtherANTHEM
INPOO266479OtherRAIL ROAD MEDICARE
IN930097175OtherRAIL ROAD MEDICARE
IN200288930Medicaid
IN226540EMedicare PIN
IN200288930Medicaid
IN000000112680Medicare PIN
IN930097175OtherRAIL ROAD MEDICARE
IN930097175Medicare PIN
IN809640BBMedicare PIN