Provider Demographics
NPI:1124248935
Name:RAPPAPORT, STEPHEN ALAN (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:ALAN
Last Name:RAPPAPORT
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 1:8025 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46240-2502
Mailing Address - Country:US
Mailing Address - Phone:317-254-1617
Mailing Address - Fax:
Practice Address - Street 1:9292 N MERIDIAN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1857
Practice Address - Country:US
Practice Address - Phone:317-846-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01032429A207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100228190AMedicaid
IN110152018Medicare PIN
B29475Medicare UPIN
IN100228190AMedicaid