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NPI Code Detail

MEDICARE: RUSSELL L JUDD M.D.

MEDICARE: RUSSELL L JUDD 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
1174400000XSpecialist01018058IN

General Provider Information

NPI Number : 1871574806
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUSSELL L JUDD M.D.
Provider Business Mailing Address
First Line : 5317 E 16TH ST
Second Line : STE 5
City : INDIANAPOLIS
State : IN
Zip : 46218-4897
Country : US
Telephone Number : 317-322-8384
Fax Number : 317-357-9070
Provider Business Practice Location Address
First Line : 5317 E 16TH ST
Second Line : STE 5
City : INDIANAPOLIS
State : IN
Zip : 46218-4897
Country : US
Telephone Number : 317-322-8384
Fax Number : 317-357-9070
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2005
Last Update Date : 07/09/2007

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Directions to “ RUSSELL L JUDD M.D.” Practice Location

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