MEDICARE: DR. RICHARD THOMAS PRALL MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01053415A	IN
2	207RG0100X	Gastroenterology Physician	01053415A	IN
3	207P00000X	Emergency Medicine Physician	01053415A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000600490	OTHER	IN	BLUE SHIELD

General Provider Information

NPI Number	:	1356318414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD THOMAS PRALL MD

Provider Business Mailing Address
First Line	:	8649 BAY COLONY DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-2912
Country	:	US
Telephone Number	:	317-297-7519
Fax Number	:

Provider Business Practice Location Address
First Line	:	8649 BAY COLONY DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-2912
Country	:	US
Telephone Number	:	317-297-7519
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	02/23/2009

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