Healthcare Provider Details

I. General information

NPI: 1962403360
Provider Name (Legal Business Name): STEVEN RUSSELL DRYDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 10/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

IV. Provider business mailing address

PO BOX 6069 DEPT. #18
INDIANAPOLIS IN
46206-6069
US

V. Phone/Fax

Practice location:
  • Phone: 317-802-6290
  • Fax: 317-870-0499
Mailing address:
  • Phone: 317-802-6290
  • Fax: 317-870-0499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number01025134
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: