Provider Demographics
NPI:1073511556
Name:VIERK, RONALD (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:VIERK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8747
Mailing Address - Fax:765-983-3008
Practice Address - Street 1:1100 REID PKWY
Practice Address - Street 2:SURGERY/ANESTHESIA DEPARTMENT
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-935-8747
Practice Address - Fax:765-983-3008
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031317207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000754277OtherANTHEM
OH0721099Medicaid
IN100134920Medicaid
INB28773Medicare UPIN
INM400060242Medicare PIN
IN906130PMedicare ID - Type UnspecifiedREID HOSPITAL ANESTHESIA