Provider Demographics
NPI:1740297142
Name:STUHLDREHER, DAVID B (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:B
Last Name:STUHLDREHER
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 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-807-1241
Mailing Address - Fax:317-859-4268
Practice Address - Street 1:1270 N POST RD
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-4209
Practice Address - Country:US
Practice Address - Phone:317-895-6095
Practice Address - Fax:317-895-6195
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045047A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100194370OtherMEDICAID GROUP NUMBER
IN1487680518OtherGROUP NPI NUMBER
IN340015552OtherMEDICARE RAILROAD
IN200082270Medicaid
IN340015553OtherMEDICARE RAILROAD
IN000000091689OtherANTHEM PROVIDER NUMBER
IN069390EMedicare PIN
IN1487680518OtherGROUP NPI NUMBER
IN100194370OtherMEDICAID GROUP NUMBER
IN340015552OtherMEDICARE RAILROAD
IN069350EMedicare PIN
IN069340EMedicare PIN