1356437727 NPI number — DR. RICHARD ANTHONY WALGREN M.D., PH.D.

Table of content: DR. RICHARD ANTHONY WALGREN M.D., PH.D. (NPI 1356437727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356437727 NPI number — DR. RICHARD ANTHONY WALGREN M.D., PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALGREN
Provider First Name:
RICHARD
Provider Middle Name:
ANTHONY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D., PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356437727
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LILLY CORPORATE CTR
Provider Second Line Business Mailing Address:
MAIL DROP CODE 2113
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46285-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-433-0801
Provider Business Mailing Address Fax Number:
317-276-9666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LILLY CORPORATE CTR
Provider Second Line Business Practice Location Address:
MAIL DROP CODE 2113
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46285-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-433-0801
Provider Business Practice Location Address Fax Number:
317-276-9666
Provider Enumeration Date:
10/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  2002014374 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 01065139A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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