Provider Demographics
NPI:1598762916
Name:DEEL, CONRAD EMERSON (MD)
Entity Type:Individual
Prefix:
First Name:CONRAD
Middle Name:EMERSON
Last Name:DEEL
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 1:1801 N SENATE BLVD
Mailing Address - Street 2:SUITE 355
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1252
Mailing Address - Country:US
Mailing Address - Phone:317-924-8420
Mailing Address - Fax:317-924-8424
Practice Address - Street 1:5255 E STOP 11 RD
Practice Address - Street 2:SUITE 440
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6340
Practice Address - Country:US
Practice Address - Phone:317-882-2857
Practice Address - Fax:317-882-2873
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058716207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200474440Medicaid
IN000000336170OtherANTHEM NUMBER
IN000000336170OtherANTHEM NUMBER
IN076330XMedicare PIN