Individual
BRADLEY A STALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 577-4200
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01057547A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200471880
—
IN
01
—
264430C46
MEDICARE PTAN
IN
01
—
Q00163581
RAILROAD PTAN
IN
Enumeration date
10/26/2005
Last updated
11/28/2023
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