Individual
ROBERT AVENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2200 N SECTION ST, SULLIVAN, IN 47882-7523
(812) 268-6292
Mailing address
PO BOX 385, SULLIVAN, IN 47882-0385
(812) 268-6292
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01038723
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
023329800
FEDERAL BLACK LUNG
IN
05
—
1003265760C
—
IN
01
—
10780065
CAQH
IN
01
—
110123778
RAILROAD MEDICARE
IN
Enumeration date
08/02/2006
Last updated
09/28/2010
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