Individual
GRENVILLE RIO-JOHN FERNANDES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
340 W 10TH ST # FS5100, INDIANAPOLIS, IN 46202-3082
(317) 948-0200
Mailing address
340 W 10TH ST # FS5100, INDIANAPOLIS, IN 46202-3082
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
01084046A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300039070
—
IN
Enumeration date
03/27/2016
Last updated
10/31/2024
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