Basic Information
| Provider Information | |||||||||
| NPI: | 1306467642 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALROD | ||||||||
| FirstName: | MADISON | ||||||||
| MiddleName: | TAYLOR | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12953 PUBLISHERS DR STE 200 | ||||||||
| Address2: | |||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460388801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175774150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1515 N MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460113457 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7652984242 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/28/2020 | ||||||||
| LastUpdateDate: | 08/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | CV2002459 | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 10003014A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.