Provider Demographics
NPI:1093712739
Name:BLOCH, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:BLOCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N SENATE BLVD
Mailing Address - Street 2:SUITE 355
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1228
Mailing Address - Country:US
Mailing Address - Phone:317-924-8425
Mailing Address - Fax:317-924-8424
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:SUITE 355
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1228
Practice Address - Country:US
Practice Address - Phone:317-924-8425
Practice Address - Fax:317-924-8424
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024845207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000083033OtherANTHEM NUMBER
IN100231450AMedicaid
IN076330CMedicare PIN
IN100231450AMedicaid