Healthcare Provider Details

I. General information

NPI: 1295717270
Provider Name (Legal Business Name): RICHARD L BEARDSLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 03/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 CHURCHMAN AVE
BEECH GROVE IN
46107-1044
US

IV. Provider business mailing address

2030 CHURCHMAN AVE
BEECH GROVE IN
46107-1044
US

V. Phone/Fax

Practice location:
  • Phone: 317-786-9285
  • Fax: 317-781-2793
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01029408A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: