MEDICARE: RUDOLPH ROUHANA

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	207Q00000X	Family Medicine Physician	01026170A	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	000000313002	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1457366171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUDOLPH ROUHANA

Provider Business Mailing Address
First Line	:	6626 E. 75TH STREET
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2890
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 N POST RD
Second Line	:	SUITE 2
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4225
Country	:	US
Telephone Number	:	317-355-6780
Fax Number	:	317-355-6782

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

Provider Enumeration Date	:	07/30/2006
Last Update Date	:	03/09/2015

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Directions to “ RUDOLPH ROUHANA ” Practice Location

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