Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 01035235 | IN |
NPI | 1003828682 |
---|---|
Provider Name | Randall M. Todd |
First Address | Indianapolis, IN 46207-7112 |
Second Address | Indianapolis, IN 46237-8601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 08/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100325030 | (05) | IN |
D95716 | (02) |