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Contact Information

THELMA L GREEN MACK, MD
3850 SHORE DRIVE
SUIOTE 305
INDIANAPOLIS, IN46254-5621
 Phone: 317-920-3220
 Fax: 317-920-3221
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pain Medicine

2081P2900X 25 Physician/Physical Medicine and Rehabilitation
 

Addiction Medicine

207RA0401X 11 Physician/Internal Medicine
 

Physical Medicine & Rehabilitation

208100000X 25 Physician/Physical Medicine and Rehabilitation
Indicates primary specialty

NPI Profile & details for THELMA L GREEN MACK · (Female)

NPI # 1841358017
Status Active
Credentials MD
Entity Individual
Enumeration date 12/04/2006
Last updated 03/09/2023 - About 3 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 01037601
  • IN License # 01037601B
  • IN Medicaid 100130200
  • IN Other 000000092241 ANTHEM BCBS
  • IN Other 1841358017 NPI
  • IN Other 250010985 RAILROAD MEDICARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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