Healthcare Provider Details

I. General information

NPI: 1285803858
Provider Name (Legal Business Name): ADRIAN SAUDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 RONALD REAGAN PKWY
AVON IN
46123-7085
US

IV. Provider business mailing address

3843 KESSLER BOULEVARD NORTH DR APT. #2018
INDIANAPOLIS IN
46228-6797
US

V. Phone/Fax

Practice location:
  • Phone: 317-217-3500
  • Fax: 317-217-3115
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01068074
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: