Provider Demographics
NPI:1497759906
Name:ROESNER, JOHN FRANKLIN (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FRANKLIN
Last Name:ROESNER
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 1:6626 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:
Mailing Address - Fax:
Practice Address - Street 1:7120 CLEARVISTA DR
Practice Address - Street 2:STE 2100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1621
Practice Address - Country:US
Practice Address - Phone:317-621-5676
Practice Address - Fax:317-621-5678
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053147A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200299300Medicaid
INP01214641OtherRR MEDICARE PTAN
IN675230NMedicare ID - Type Unspecified
IN266180177Medicare PIN
INP01214641OtherRR MEDICARE PTAN
IN200299300Medicaid