Individual
MARK D BEVILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(888) 484-3258
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
R-10846
IA
208800000X
Urology Physician
Primary
01090017A
IN
208800000X
Urology Physician
R-10846
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
064740078
MEDICARE PTAN
IN
01
—
1103128902
ANTHEM PTAN
IN
05
—
300077614
—
IN
01
—
815500654
MEDICARE PTAN
IN
01
—
Q00573984
RAILROAD PTAN
IN
Enumeration date
05/30/2017
Last updated
03/07/2025
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