Healthcare Provider Details

I. General information

NPI: 1770659989
Provider Name (Legal Business Name): ROLANDO M QUILATON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1664 W SMITH VALLEY RD
GREENWOOD IN
46142-1550
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-887-7640
  • Fax: 317-887-7664
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number01041310
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: