Provider Demographics
NPI:1881641520
Name:MIDLA, TODD E (DO)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:E
Last Name:MIDLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 GUION RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1691
Mailing Address - Country:US
Mailing Address - Phone:317-920-7432
Mailing Address - Fax:317-920-7446
Practice Address - Street 1:3660 GUION RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1697
Practice Address - Country:US
Practice Address - Phone:317-920-7432
Practice Address - Fax:317-920-7446
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001032A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN712430AMedicare ID - Type Unspecified
INE43882Medicare UPIN