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Individual

MATTHEW RYAN WANNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1125 W JEFFERSON ST, FRANKLIN, IN 46131-2140
(317) 472-4565
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
(317) 715-6402

Taxonomy

Speciality
Code
Description
License number
State
2085P0229X
Pediatric Radiology Physician
01055281A
IN
2085R0202X
Diagnostic Radiology Physician
Primary
01055281
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200526920
IN
01
P00319271
RAILROAD MEDICARE
IN
Enumeration date
07/26/2006
Last updated
08/08/2025
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