Provider Demographics
NPI:1821210766
Name:MAXWELL PFLIEGER, JANELLE (DO)
Entity type:Individual
Prefix:
First Name:JANELLE
Middle Name:
Last Name:MAXWELL PFLIEGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JANELLE
Other - Middle Name:LEE
Other - Last Name:PFLIEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 HAUENSTEIN RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-8803
Mailing Address - Country:US
Mailing Address - Phone:260-204-0505
Mailing Address - Fax:260-204-0504
Practice Address - Street 1:225 HAUENSTEIN RD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-8803
Practice Address - Country:US
Practice Address - Phone:260-204-0505
Practice Address - Fax:260-204-0504
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300000276Medicaid
CO60339233Medicaid