Individual
MARISS L SRADERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 N RITTER AVE, SUITE 510, INDIANAPOLIS, IN 46219-3052
(317) 355-2050
(317) 355-2051
Mailing address
6626 E 75TH ST, 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
01048743A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000764780
ANTHEM
IN
05
—
200200940
—
IN
05
—
200519540A
—
IN
01
—
P01115570
RAILROAD MEDICARE
IN
Enumeration date
03/21/2006
Last updated
11/27/2023
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