Provider Demographics
NPI:1487621769
Name:NEBESIO, TODD DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:DAVID
Last Name:NEBESIO
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-777-6435
Mailing Address - Fax:317-777-6644
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:RI 5960
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-3889
Practice Address - Fax:317-944-3882
Is Sole Proprietor?:No
Enumeration Date:2006-03-04
Last Update Date:2020-12-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01061663A2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200807560Medicaid
OH3071849Medicaid
I63951Medicare UPIN
IN200807560Medicaid