Provider Demographics
NPI:1770926453
Name:TODD E. MIDLA, D.O.,P.C.
Entity type:Organization
Organization Name:TODD E. MIDLA, D.O.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDENOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-920-7432
Mailing Address - Street 1:3660 GUION RD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1697
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:SUITE 230
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02001032A207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty