Individual
TARA LEIGH ROEDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2118 25TH ST STE C, COLUMBUS, IN 47201-3240
(812) 376-9427
Mailing address
PO BOX 775383, CHICAGO, IL 60677-5383
(812) 376-5315
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01059424A
IN
207R00000X
Internal Medicine Physician
Primary
01059424A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000991666
ANTHEM PIN
IN
05
—
200525700
—
IN
Enumeration date
05/23/2006
Last updated
03/13/2026
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