MEDICARE: ROBERT D. MCQUISTON, M.D., INC

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	207YS0012X	Sleep Medicine (Otolaryngology) Physician	01022807A	IN

General Provider Information

NPI Number	:	1629295951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT D. MCQUISTON, M.D., INC

Provider Business Mailing Address
First Line	:	8216 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6013
Country	:	US
Telephone Number	:	317-887-6707
Fax Number	:	317-887-5470

Provider Business Practice Location Address
First Line	:	8216 MADISON AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-6013
Country	:	US
Telephone Number	:	317-887-6707
Fax Number	:	317-887-5470

Authorized Official
Title or Position	:	OFFICE ASSISTANT
Name	:	MRS. RENA M DAPRILE
Credential	:
Telephone Number	:	317-887-6707

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	09/04/2007

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