Provider Demographics
NPI:1740262351
Name:TRUDGEN, SPENCER F (MD)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:F
Last Name:TRUDGEN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 NAAB RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5927
Mailing Address - Country:US
Mailing Address - Phone:317-872-3459
Mailing Address - Fax:317-875-3231
Practice Address - Street 1:8240 NAAB RD
Practice Address - Street 2:SUITE 400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5927
Practice Address - Country:US
Practice Address - Phone:317-872-3459
Practice Address - Fax:317-875-3231
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2025-03-30
Deactivation Date:2014-12-16
Deactivation Code:
Reactivation Date:2015-02-17
Provider Licenses
StateLicense IDTaxonomies
IN01019136A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100382020Medicaid
IN160020850Medicare PIN
INB28074Medicare UPIN
IN677690YMedicare PIN