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General NPI Number Information
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NPI Number | 1912029257
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Entity Type | Organization
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Legal Business Name | RIVIERA PEDIATRICS LLC
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4115 OFFICE PLAZA BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-2408
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Country | US
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Telephone | 317-297-3507
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Fax | 317-290-2557
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Provider Business Mailing Address
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Address Line | 4115 OFFICE PLAZA BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-2408
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Country | US
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Telephone | 317-297-3507
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Fax | 317-290-2557
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Authorized Official
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Title or Position | DR OWNER
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Name | DR. DONALD K LEEDY
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Credential | M.D.
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Telephone | 317-297-3507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 01021195A
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License Number State | IN
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