Provider Demographics
NPI:1649324401
Name:MONN, LARRY NEIL (MD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:NEIL
Last Name:MONN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8040 CLEARVISTA PKWY
Mailing Address - Street 2:SUITE 540
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-5630
Mailing Address - Country:US
Mailing Address - Phone:317-621-3900
Mailing Address - Fax:317-621-3902
Practice Address - Street 1:8040 CLEARVISTA PKWY
Practice Address - Street 2:SUITE 540
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5630
Practice Address - Country:US
Practice Address - Phone:317-621-3900
Practice Address - Fax:317-621-3902
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021544A2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100057220AMedicaid
IN000000083901OtherANTHEM
IN000000083901OtherANTHEM
IN063980Medicare PIN