Provider Demographics
NPI:1215987185
Name:ORTMANN, ROBERT ALAN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:ORTMANN
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:LILLY CORPORATE CTR
Mailing Address - Street 2:DC 1940
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46285-0001
Mailing Address - Country:US
Mailing Address - Phone:317-433-2779
Mailing Address - Fax:
Practice Address - Street 1:LILLY CORPORATE CTR
Practice Address - Street 2:DC 1940
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46285-0001
Practice Address - Country:US
Practice Address - Phone:317-433-2779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001005641207RR0500X
ARE-5590207RR0500X
IN01072827A207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR167965001Medicaid
MOP00415665OtherRAILROAD MEDICARE
MO205295900Medicaid
ARE-5590OtherARKANSAS MEDICAL LICENSE
MO660003367OtherRR MEDICARE
MO205295900Medicaid
MO897010635Medicare PIN
MOP00415665OtherRAILROAD MEDICARE
AR167965001Medicaid
MO932651444Medicare PIN