Individual
TODD R FOGELSONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
13121 OLIO RD, SUITE 300, FISHERS, IN 46037-7237
(317) 621-1300
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02004531A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201172960
—
IN
01
—
P01723978
RR MEDICARE
IN
Enumeration date
05/17/2013
Last updated
11/27/2023
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