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Individual

SAMUEL IDEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1100 REID PKWY, RICHMOND, IN 47374-1157
(317) 217-3000
(317) 870-0499
Mailing address
1100 REID PARKWAY, MEDICAL STAFF SERVICES, RICHMOND, IN 47374
(765) 983-3127
(765) 983-3219

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01060922
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200844460
IN
Enumeration date
12/06/2006
Last updated
05/25/2021
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