Provider Demographics
NPI:1386813210
Name:VAHLE, JUDITH C (MD)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:C
Last Name:VAHLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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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:317-355-7199
Mailing Address - Fax:317-355-9022
Practice Address - Street 1:1303 N ARLINGTON AVE
Practice Address - Street 2:SUITE # 2
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-8300
Practice Address - Country:US
Practice Address - Phone:317-359-9671
Practice Address - Fax:317-359-9672
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01067683A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200990950Medicaid
INP01009918OtherRR MEDICARE PTAN
IN200990950Medicaid