=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285803858
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRIAN SAUDER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2008
-----------------------------------------------------
Last Update Date | 02/11/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 RONALD REAGAN PKWY
-----------------------------------------------------
City | AVON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46123-7085
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-217-3500
-----------------------------------------------------
Fax | 317-217-3115
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3843 KESSLER BOULEVARD NORTH DR APT. #2018
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46228-6797
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 01068074
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------