Provider Demographics
NPI:1356315014
Name:HULSEMAN, MARY LOU (MD)
Entity type:Individual
Prefix:
First Name:MARY LOU
Middle Name:
Last Name:HULSEMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11530 ALLISONVILLE RD STE 175
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1865
Mailing Address - Country:US
Mailing Address - Phone:317-348-3228
Mailing Address - Fax:317-348-3228
Practice Address - Street 1:11530 ALLISONVILLE RD STE 175
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1865
Practice Address - Country:US
Practice Address - Phone:317-348-3228
Practice Address - Fax:317-348-3228
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2024-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047254A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000344909OtherANTHEM
IN200201750Medicaid
IN000000344909OtherANTHEM
INP00162616Medicare PIN
221470BMedicare PIN
IN200201750Medicaid