Individual
DANIEL E RUSYNIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 W 10TH ST, INDIANAPOLIS, IN 46202-2859
(317) 630-7276
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
01047125A
IN
207PT0002X
Medical Toxicology (Emergency Medicine) Physician
01047125A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000205421
ANTHEM
IN
05
—
200159850
—
IN
Enumeration date
08/30/2006
Last updated
03/06/2025
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