Provider Demographics
NPI:1447514682
Name:DILLON, SEAN RUSSELL (MD)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:RUSSELL
Last Name:DILLON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7439 WOODLAND DR STE 105
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46278-1940
Mailing Address - Country:US
Mailing Address - Phone:317-567-1069
Mailing Address - Fax:317-981-1538
Practice Address - Street 1:7439 WOODLAND DR STE 105
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278
Practice Address - Country:US
Practice Address - Phone:765-407-1291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-03
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01079539A207Q00000X
KY47180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100310690Medicaid
KY7100310690Medicaid