Individual
TENDEUKAI RATIDZO WARREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 962-3886
(317) 962-5492
Mailing address
250 N SHADELAND AVE, SUITE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
(317) 962-3886
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01075790A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11017207A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201171870
—
IN
Enumeration date
04/10/2013
Last updated
12/02/2016
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