Healthcare Provider Details

I. General information

NPI: 1093712739
Provider Name (Legal Business Name): RICHARD BLOCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 N SENATE BLVD SUITE 355
INDIANAPOLIS IN
46202-1228
US

IV. Provider business mailing address

1801 N SENATE BLVD SUITE 355
INDIANAPOLIS IN
46202-1228
US

V. Phone/Fax

Practice location:
  • Phone: 317-924-8425
  • Fax: 317-924-8424
Mailing address:
  • Phone: 317-924-8425
  • Fax: 317-924-8424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number01024845
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: