=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902063225
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TODD A EADS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2008
-----------------------------------------------------
Last Update Date | 12/04/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 719 W 2ND ST
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47403-2209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-396-1300
-----------------------------------------------------
Fax | 317-329-3040
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8333 NAAB RD SUITE 250
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46260-5924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-396-1300
-----------------------------------------------------
Fax | 317-329-3040
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | 8139
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | A119024
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | 01062771A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------