Healthcare Provider Details

I. General information

NPI: 1174840193
Provider Name (Legal Business Name): MATTHEW DAVID DURBIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 RILEY HOSPITAL DR RR 208
INDIANAPOLIS IN
46202-5109
US

IV. Provider business mailing address

PO BOX 719094
CHICAGO IL
60677-9318
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-4779
  • Fax: 317-948-9806
Mailing address:
  • Phone: 317-777-6435
  • Fax: 317-777-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01076884A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: