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Individual

MR. RODERICK NISI

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1601 MEDICAL ARTS BLVD, SUITE 102, ANDERSON, IN 46011-3458
(765) 298-4720
(765) 298-4958
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
01036283
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000085348
ANTHEM
IN
01
100009521
RAILROAD MEDICARE
IN
01
10004427
TCARE
IN
05
100176670
IN
05
100176670B
IN
05
64042377
KY
01
P01512511
MEDICARE RR
IN
Enumeration date
10/18/2006
Last updated
11/16/2016
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