Provider Demographics
NPI:1740657469
Name:SUMMERS, LELIA JUNE (PA)
Entity type:Individual
Prefix:
First Name:LELIA
Middle Name:JUNE
Last Name:SUMMERS
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1100 SOUTHFIELD DR STE 1220
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-4499
Mailing Address - Country:US
Mailing Address - Phone:317-838-8334
Mailing Address - Fax:317-838-3444
Practice Address - Street 1:1100 SOUTHFIELD DR STE 1220
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-4499
Practice Address - Country:US
Practice Address - Phone:317-838-3443
Practice Address - Fax:317-838-3444
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2022-01-28
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Provider Licenses
StateLicense IDTaxonomies
IN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN681070AMedicare UPIN