MEDICARE: DR. RAYMOND VICTOR MELDAHL 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	174400000X	Specialist	01040597A	IN
2	207RC0000X	Cardiovascular Disease Physician	01040597A	IN
3	207RI0011X	Interventional Cardiology Physician	01040597A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00861438	OTHER	IN	RR MEDICARE PTAN
4	P01212108	OTHER	IN	RR MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	P000861438	OTHER	IN	RAILROAD

General Provider Information

NPI Number	:	1669446977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAYMOND VICTOR MELDAHL M.D.

Provider Business Mailing Address
First Line	:	1515 N PARK AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2608
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 N PARK AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-2608
Country	:	US
Telephone Number	:	317-431-1437
Fax Number	:

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	10/15/2019

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Directions to “ DR. RAYMOND VICTOR MELDAHL M.D.” Practice Location

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