Provider Demographics
NPI:1306830740
Name:RALSTON, MICHAEL E (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:RALSTON
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 1:5255 E STOP 11 RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-6340
Mailing Address - Country:US
Mailing Address - Phone:317-528-4723
Mailing Address - Fax:317-528-4699
Practice Address - Street 1:5255 E STOP 11 RD
Practice Address - Street 2:SUITE 300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6340
Practice Address - Country:US
Practice Address - Phone:317-528-4723
Practice Address - Fax:317-528-4699
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01062889A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200840220Medicaid
IN200840220Medicaid