Individual
MATTHEW E DEBURGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CAA
Contact information
Practice address
705 RILEY HOSPITAL DR RM 2820, INDIANAPOLIS, IN 46202-5109
(317) 944-9981
(317) 944-0282
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
75000029A
IN
367H00000X
Anesthesiologist Assistant
75000029A
IN
367H00000X
Anesthesiologist Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001259263
ANTHEM PTAN
IN
01
—
1100230119
ANTHEM PTAN
IN
Enumeration date
07/07/2015
Last updated
12/02/2024
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