Provider Demographics
NPI:1255345021
Name:RICHARD, BERNARD (MD)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:RICHARD
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:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-318-7712
Mailing Address - Fax:317-318-7700
Practice Address - Street 1:740 W GREEN MEADOWS DR
Practice Address - Street 2:SUITE 105
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-3098
Practice Address - Country:US
Practice Address - Phone:317-318-7777
Practice Address - Fax:317-318-7700
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060462A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200531790Medicaid
IN000000377731OtherANTHEM
INP01014103OtherRR MEDICARE PTAN
INI42173Medicare UPIN
INM400037974Medicare PIN
IN000000377731OtherANTHEM
IN200531790Medicaid
IN823720OOOOMedicare PIN