Provider Demographics
NPI:1316951916
Name:FOGLE, NORMAN (MD)
Entity type:Individual
Prefix:
First Name:NORMAN
Middle Name:
Last Name:FOGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6910 HILLSDALE CT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2040
Practice Address - Country:US
Practice Address - Phone:317-621-6337
Practice Address - Fax:317-621-6366
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025348A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00971550OtherRR MEDICARE PTAN
IN000000313343OtherANTHEM
IN100057930Medicaid
INM400037982Medicare PIN
INM400037978Medicare PIN
IN000000313343OtherANTHEM
INM400040679Medicare PIN
INM400037984Medicare PIN
INM400037980Medicare PIN
INB28191Medicare UPIN
IN100057930Medicaid
INM400037981Medicare PIN
IN214180DMedicare PIN