MEDICARE: BENJAMIN J RICKE M.D.

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	207P00000X	Emergency Medicine Physician	01065630A	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

General Provider Information

NPI Number	:	1447457767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN J RICKE M.D.

Provider Business Mailing Address
First Line	:	584 N COUNTY ROAD 1050 E
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46234-8936
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	I-65 AT 21ST STREET
Second Line	:	METHODIST HOSPITAL, ROOM B401
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46206
Country	:	US
Telephone Number	:	317-962-5975
Fax Number	:

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	09/23/2020

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