Individual
RONALD L BANTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
3077 E 98TH ST, INDIANAPOLIS, IN 46280-2940
(317) 843-2613
(317) 574-5185
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
213ES0000X
Sports Medicine Podiatrist
Primary
07000296A
IN
213ES0103X
Foot & Ankle Surgery Podiatrist
07000296A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100461080
—
IN
01
—
P01424283
RAIL ROAD PTAN
IN
Enumeration date
06/02/2006
Last updated
11/27/2023
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