Healthcare Provider Details

I. General information

NPI: 1902063225
Provider Name (Legal Business Name): TODD A EADS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 W 2ND ST
BLOOMINGTON IN
47403-2209
US

IV. Provider business mailing address

8333 NAAB RD SUITE 250
INDIANAPOLIS IN
46260-5924
US

V. Phone/Fax

Practice location:
  • Phone: 317-396-1300
  • Fax: 317-329-3040
Mailing address:
  • Phone: 317-396-1300
  • Fax: 317-329-3040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number8139
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA119024
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number01062771A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: