Individual
DR. RUSSELL S DILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 N RITTER AVE, SUITE # 520, INDIANAPOLIS, IN 46219-3052
(317) 355-1234
(317) 355-1505
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
01026646
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100064180A
—
IN
01
—
P01214606
RR MEDICARE PTAN
IN
Enumeration date
06/30/2006
Last updated
09/07/2017
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