Healthcare Provider Details

I. General information

NPI: 1376292227
Provider Name (Legal Business Name): RYAN DAVIS PLUNKETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 ROTARY CIR STE 225
INDIANAPOLIS IN
46202-5133
US

IV. Provider business mailing address

702 ROTARY CIR STE 225
INDIANAPOLIS IN
46202-5133
US

V. Phone/Fax

Practice location:
  • Phone: 317-278-4427
  • Fax:
Mailing address:
  • Phone: 317-278-4427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number01099568A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number01099568A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: