Provider Demographics
NPI:1578522850
Name:DEITCH, ROBERT D (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:DEITCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10300 N ILLINOIS ST
Mailing Address - Street 2:SUITE 1040
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1166
Mailing Address - Country:US
Mailing Address - Phone:317-817-1765
Mailing Address - Fax:317-817-1767
Practice Address - Street 1:10300 N ILLINOIS ST
Practice Address - Street 2:SUITE 1040
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1166
Practice Address - Country:US
Practice Address - Phone:317-817-1765
Practice Address - Fax:317-817-1767
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2017-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01033749207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100068910CMedicaid
IN316690Medicare PIN
D46999Medicare UPIN
IN100068910CMedicaid