Individual
KEITH R RIDEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7250 CLEARVISTA DR STE 225, INDIANAPOLIS, IN 46256-5626
(317) 537-6088
(317) 537-6092
Mailing address
6983 HILLSDALE CT, INDIANAPOLIS, IN 46250-2054
(317) 849-8350
(317) 576-6311
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
01067562A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200978240
—
IN
Enumeration date
05/17/2007
Last updated
02/10/2023
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