Provider Demographics
NPI:1295736536
Name:WUDUNN, DARRELL (MD)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:
Last Name:WUDUNN
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 1:550 UNIVERSITY BLVD
Mailing Address - Street 2:SUITE 3080
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5149
Mailing Address - Country:US
Mailing Address - Phone:317-274-1034
Mailing Address - Fax:317-274-3265
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:SUITE 3005
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-274-8937
Practice Address - Fax:317-274-2727
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044384207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF43121Medicare UPIN
IN267210Medicare ID - Type Unspecified