MEDICARE: PATRICK DANIEL REIBOLD MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	01042143	IN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	130014906	OTHER	IN	RR MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4455269	OTHER	IN	AETNA REFERRAL NUMBER
4	000000091276	OTHER	IN	ANTHEM
6	129480500	OTHER	IN	DEPT OF LABOR

NPI Number	:	1417928367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK DANIEL REIBOLD MD

Provider Business Mailing Address
First Line	:	13450 N MERIDIAN ST STE 354
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-1486
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13450 N MERIDIAN ST STE 354
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-1486
Country	:	US
Telephone Number	:	317-249-0990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	11/10/2022

13450 N. MERIDIAN STREET , STE 355
CARMEL, IN
46032-1486

Practice Phone: 317-575-2700
Practice Fax: 317-575-2713