Provider Demographics
NPI:1376535880
Name:SEXSON, STEPHEN B (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:B
Last Name:SEXSON
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 1:7436 GLENVISTA PL
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1190
Mailing Address - Country:US
Mailing Address - Phone:317-845-0889
Mailing Address - Fax:
Practice Address - Street 1:7436 GLENVISTA PL
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1190
Practice Address - Country:US
Practice Address - Phone:317-845-0889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033281A207XX0005X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01128032OtherRAILROAD MEDICARE
IN100126850Medicaid
IN200018582OtherRAILROAD MEDICARE
IN100126850Medicaid
IN261280AMedicare PIN
IN0358680001Medicare NSC
INM400072701Medicare PIN