Provider Demographics
NPI:1528152238
Name:MAIER, JON MICHAEL (MD)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:MICHAEL
Last Name:MAIER
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 ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3458
Practice Address - Country:US
Practice Address - Phone:765-298-4720
Practice Address - Fax:765-298-4958
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1027816207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000085347OtherANTHEM
110004270OtherTCARE
INP01588246OtherRR MEDICARE
KY64042385Medicaid
110152365OtherRAILROAD
IN00317990AMedicaid
IN100317990Medicaid
110004270OtherTCARE COMMUNITY ANDERSON
IN100317990Medicaid
IN000000085347OtherANTHEM
IN00317990AMedicaid
KY64042385Medicaid
IN504980Medicare PIN
INP01588246OtherRR MEDICARE