Provider Demographics
NPI:1417970062
Name:GREENFIELD, RACHEL R
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:R
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:317-355-2184
Mailing Address - Fax:317-355-7329
Practice Address - Street 1:10122 E 10TH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2887
Practice Address - Country:US
Practice Address - Phone:317-355-7337
Practice Address - Fax:317-355-7329
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055654A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000384643OtherANTHEM
IN200446120Medicaid
INM400037767Medicare PIN
INH86706Medicare UPIN
INM400043085Medicare PIN