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Individual

DR. RICARDO R DOROTHEO III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1600 23RD ST, BEDFORD, IN 47421-4704
(812) 276-1240
(812) 276-1237
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01042508A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000594471
BLUE SHIELD
IN
05
200008310
IN
Enumeration date
07/26/2006
Last updated
01/25/2021
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