Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 01050199A | IN |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 01050199A | IN |
NPI | 1619981545 |
---|---|
Provider Name | Martina F. Mutone |
First Address | Greenwood, IN 46143-1049 |
Second Address | Fishers, IN 46037-0051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 16/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000359695 | ANTHEM (01) | IN |
200498030 | (05) | IN |
H56512 | (02) | IN |
P00220118 | MEDICARE RAILROAD (01) | IN |