| My Mobile MD Illinois LLC | |
|
429 E Vermont St Ste 110 Indianapolis IN 46202-3685 | |
| (317) 559-0950 | |
| Not Available |
| Full Name | My Mobile MD Illinois LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 429 E Vermont St Ste 110, Indianapolis, Indiana |
| Authorized Official Name and Position | Steve Martin (CEO) |
| Authorized Official Contact | 3176706635 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| My Mobile MD Illinois LLC Po Box 586 Galloway OH 43119-0586 Ph: (765) 969-7841 | My Mobile MD Illinois LLC 429 E Vermont St Ste 110 Indianapolis IN 46202-3685 Ph: (317) 559-0950 |
| NPI Number | 1366324543 |
|---|---|
| Provider Enumeration Date | 07/21/2025 |
| Last Update Date | 07/21/2025 |
| Certification Date | 07/21/2025 |
| Medicare PECOS PAC ID | 0941701239 |
|---|---|
| Medicare Enrollment ID | O20250828003357 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366324543 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| Provider Name | Pamela S Brodt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982737789 PECOS PAC ID: 3577658590 Enrollment ID: I20071004000696 |
| Provider Name | Malissa a Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285113217 PECOS PAC ID: 6901157932 Enrollment ID: I20181008001657 |
| Provider Name | Melissa K Odle |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225308406 PECOS PAC ID: 1850630617 Enrollment ID: I20190222001403 |
| Provider Name | Shaun P Cox |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487989513 PECOS PAC ID: 1052581964 Enrollment ID: I20240507003521 |
| Provider Name | Ryan Matthew Pickell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1578943460 PECOS PAC ID: 3870805294 Enrollment ID: I20250905001346 |
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