Healthcare Provider Details

I. General information

NPI: 1487808044
Provider Name (Legal Business Name): SCOTT RIDDELL MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12065 OLD MERIDIAN ST STE 100
CARMEL IN
46032-8774
US

IV. Provider business mailing address

12065 OLD MERIDIAN ST STE 100
CARMEL IN
46032-8774
US

V. Phone/Fax

Practice location:
  • Phone: 317-844-5351
  • Fax: 317-844-0310
Mailing address:
  • Phone: 317-844-5351
  • Fax: 317-844-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01037635A
License Number StateIN

VIII. Authorized Official

Name: DR. SCOTT RIDDELL
Title or Position: PEDIATRICIAN
Credential: MD
Phone: 317-844-5351