Healthcare Provider Details

I. General information

NPI: 1659012300
Provider Name (Legal Business Name): RICARDO ANTONIO SERRANO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 W. 16TH STREET, #2364. INDIANAPOLIS, IN 46202
INDIANAPOLIS IN
46202
US

IV. Provider business mailing address

355 W. 16TH STREET, #2364. INDIANAPOLIS, IN 46202
INDIANAPOLIS IN
46202
US

V. Phone/Fax

Practice location:
  • Phone: 317-963-7288
  • Fax:
Mailing address:
  • Phone: 317-963-7288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number11022552A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number11022552A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number11022552A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number11022552A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code323P00000X
TaxonomyPsychiatric Residential Treatment Facility
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number11022552A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: