Basic Information
| Provider Information | |||||||||
| NPI: | 1477636371 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARIASH | ||||||||
| FirstName: | CARY | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 N SHADELAND AVE | ||||||||
| Address2: | STE 130 PROVIDER ENROLLMENT | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462194959 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 201 PENNSYLVANIA PKWY | ||||||||
| Address2: | STE 310 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462802301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178130000 | ||||||||
| FaxNumber: | 3175734064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 01/14/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 20921 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | 20921 | MN | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RE0101X | 01065821 | IN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 200929970 | 05 | IN | MEDICAID | 33-70016 | 01 | MEDICA PRIMARY | OTHER | 1009230 | 01 | PREFERRED ONE | OTHER | HP22058 | 01 | HEALTH PARTNERS | OTHER | 0064889 | 05 | MT | MEDICAID | 2T162MA | 01 | BLUE CROSS BLUE SHIELD | OTHER | 3324572 | 01 | MEDICA CHOICE | OTHER | 738798900 | 05 | MN | MEDICAID | 644606 | 01 | ARAZ | OTHER | 101018 | 01 | UCARE | OTHER |