Provider Demographics
NPI:1194802611
Name:HALLETT, PATRICIA ANN (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:HALLETT
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 1:106 S STATE ROAD 135 STE C
Mailing Address - Street 2:
Mailing Address - City:TRAFALGAR
Mailing Address - State:IN
Mailing Address - Zip Code:46181-8702
Mailing Address - Country:US
Mailing Address - Phone:317-878-4972
Mailing Address - Fax:317-878-4593
Practice Address - Street 1:106 S STATE ROAD 135 STE C
Practice Address - Street 2:
Practice Address - City:TRAFALGAR
Practice Address - State:IN
Practice Address - Zip Code:46181-8702
Practice Address - Country:US
Practice Address - Phone:317-878-4972
Practice Address - Fax:317-878-4593
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2021-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01057873207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200452870Medicaid
IN151560HHHHMedicare PIN
IN200452870Medicaid
P00230595Medicare PIN
IN151850EEMedicare PIN