Provider Demographics
NPI:1881336634
Name:YOUNG, MOLLY (DPM)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:YOUNG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-7468
Mailing Address - Fax:
Practice Address - Street 1:10122 E 10TH ST STE 210
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2664
Practice Address - Country:US
Practice Address - Phone:317-355-7356
Practice Address - Fax:317-806-1175
Is Sole Proprietor?:No
Enumeration Date:2022-04-12
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000454A390200000X
390200000X
IN07001498A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300063663Medicaid