Healthcare Provider Details

I. General information

NPI: 1255673000
Provider Name (Legal Business Name): CALLYN B. RIGGS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CALLYN E. BRAUN MD

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 RONALD REAGAN PKWY B1100
AVON IN
46123-7085
US

IV. Provider business mailing address

PO BOX 1026
INDIANAPOLIS IN
46206-1026
US

V. Phone/Fax

Practice location:
  • Phone: 317-948-2700
  • Fax: 317-948-2959
Mailing address:
  • Phone: 317-948-2700
  • Fax: 317-948-2959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01076545
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier201177380
Identifier TypeMEDICAID
Identifier StateIN
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: