Provider Demographics
NPI:1265564488
Name:KING, MICHAEL S (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S. MERIDIAN ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46225-1076
Mailing Address - Country:US
Mailing Address - Phone:317-637-4343
Mailing Address - Fax:317-637-4344
Practice Address - Street 1:200 S. MERIDIAN ST
Practice Address - Street 2:SUITE 400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46225-1076
Practice Address - Country:US
Practice Address - Phone:317-637-4343
Practice Address - Fax:317-637-4344
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01023916A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100056890AMedicaid
IN10825400OtherCAQH ID#
IN10825400OtherCAQH ID#