Provider Demographics
NPI:1780242578
Name:MACIAS, CHARLES JR (HAD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:MACIAS
Suffix:JR
Gender:M
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8650 VALLEY LAKE CT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-6925
Mailing Address - Country:US
Mailing Address - Phone:317-590-4151
Mailing Address - Fax:
Practice Address - Street 1:600 IRONWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-8324
Practice Address - Country:US
Practice Address - Phone:317-668-3145
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001526A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty