Healthcare Provider Details

I. General information

NPI: 1174508345
Provider Name (Legal Business Name): ROBERT D LODGE-RIGAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2005
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 WEST SECOND STREET
BLOOMINGTON IN
47402-2317
US

IV. Provider business mailing address

5700 SOUTHWYCK BLVD
TOLEDO OH
43614-1509
US

V. Phone/Fax

Practice location:
  • Phone: 812-336-6821
  • Fax: 419-866-5453
Mailing address:
  • Phone: 800-288-8325
  • Fax: 419-866-5453

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number01042328A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: