Provider Demographics
NPI:1235105354
Name:REED, ROBERT LAWRENCE II (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:REED
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:LAWRENCE
Other - Last Name:REED
Other - Suffix:II
Other - Last Name Type:Other Name
Other - Credentials:MD
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 1:1701 N SENATE AVE
Practice Address - Street 2:ROOM B240, CLARIAN METHODIST HOSPITAL
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5306
Practice Address - Country:US
Practice Address - Phone:317-962-5339
Practice Address - Fax:317-962-8028
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36098271208600000X, 2086S0102X
IN01067300A2086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200853250Medicaid
IN000000636165OtherANTHEM PIN
C20937Medicare UPIN
IN000000636165OtherANTHEM PIN
IL523900Medicare PIN
IN233690OOOMedicare PIN