Healthcare Provider Details

I. General information

NPI: 1760502165
Provider Name (Legal Business Name): RONALD T. INDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 04/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2455 N 124TH ST
BROOKFIELD WI
53005-4630
US

IV. Provider business mailing address

720 COOL SPRINGS BLVD SUITE 300
FRANKLIN TN
37067-2626
US

V. Phone/Fax

Practice location:
  • Phone: 615-778-4066
  • Fax: 615-778-9114
Mailing address:
  • Phone: 615-778-4066
  • Fax: 615-778-9114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number17997
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: