Healthcare Provider Details

I. General information

NPI: 1508285388
Provider Name (Legal Business Name): PAUL EDWARD RODENHOUSE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 05/08/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S CREASY LN STE 120
LAFAYETTE IN
47905-7433
US

IV. Provider business mailing address

8450 NORTHWEST BLVD
INDIANAPOLIS IN
46278-1381
US

V. Phone/Fax

Practice location:
  • Phone: 765-447-4165
  • Fax: 765-447-4168
Mailing address:
  • Phone: 317-802-2000
  • Fax: 317-802-2170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number02005988A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number02005988A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: