Provider Demographics
NPI:1841394830
Name:RILEY, JOHN D (MD MPH)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:RILEY
Suffix:
Gender:M
Credentials:MD MPH
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:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9894 E 121ST ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037
Practice Address - Country:US
Practice Address - Phone:317-621-6060
Practice Address - Fax:317-355-6965
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01042451A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100461800Medicaid
IN000000220469OtherANTHEM
IL110236660OtherRR MEDICARE
F47929Medicare UPIN
IL110236660OtherRR MEDICARE
INM400059628Medicare PIN