Basic Information
| Provider Information | |||||||||
| NPI: | 1417614678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERDELY | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13430 N MERIDIAN ST STE 367 | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460321484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178022000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 13430 N MERIDIAN ST STE 367 | ||||||||
| Address2: | |||||||||
| City: | CARMEL | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460321484 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178022000 | ||||||||
| FaxNumber: | 3175690573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2021 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 28205845A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363L00000X | 71012274A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.