Healthcare Provider Details

I. General information

NPI: 1356325187
Provider Name (Legal Business Name): ROBERT M MENEGHINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W 103RD ST STE 1400
INDIANAPOLIS IN
46290-1018
US

IV. Provider business mailing address

950 N MERIDIAN ST STE 500
INDIANAPOLIS IN
46204-3908
US

V. Phone/Fax

Practice location:
  • Phone: 317-688-5980
  • Fax: 317-566-2736
Mailing address:
  • Phone: 317-962-4944
  • Fax: 317-962-4950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number01059735A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number01059735
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number046288
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: