Provider Demographics
NPI:1619925757
Name:REED, RANDALL J (MD)
Entity Type:Individual
Prefix:
First Name:RANDALL
Middle Name:J
Last Name:REED
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 1:8902 N MERIDIAN ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5382
Mailing Address - Country:US
Mailing Address - Phone:317-844-6444
Mailing Address - Fax:317-848-6605
Practice Address - Street 1:8902 N MERIDIAN ST
Practice Address - Street 2:SUITE 210
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5382
Practice Address - Country:US
Practice Address - Phone:317-844-6444
Practice Address - Fax:317-848-6605
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056438A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000614106OtherANTHEM BCBS
INP00743610OtherRAILROAD MEDICARE
IN200021500Medicaid
IN354590UUMedicare PIN
IN675920YMedicare PIN
INP00743610OtherRAILROAD MEDICARE
ING07027Medicare UPIN
IN200021500Medicaid