Individual
RICHARD S WITHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
545 BARNHILL DR, EH 500, INDIANAPOLIS, IN 46202-5112
(317) 274-3086
(317) 274-0241
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01024020A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000340403
BLUE CROSS
IN
01
—
000000751683
ANTHEM PIN
IN
05
—
100186120
—
IN
Enumeration date
03/15/2006
Last updated
03/12/2014
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