Individual
RICHARD T MIYAMOTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
705 RILEY HOSPITAL DR, SUITE 0860, INDIANAPOLIS, IN 46202-5109
(317) 274-3556
(317) 278-3743
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207YX0901X
Otology & Neurotology Physician
Primary
01024300
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100061170
—
IN
Enumeration date
06/30/2006
Last updated
02/18/2014
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