Provider Demographics
NPI:1871537845
Name:RYAN, TODD A (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:A
Last Name:RYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:STE 130 PROVIDER ENROLLMENT
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4880 CENTURY PLAZA RD
Practice Address - Street 2:STE 265
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5471
Practice Address - Country:US
Practice Address - Phone:317-216-2700
Practice Address - Fax:317-216-2777
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01038920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100101160Medicaid
IN100101160Medicaid
INM400014567Medicare PIN
INP00859182Medicare PIN
IN646050OMedicare PIN