Provider Demographics
NPI:1598262438
Name:RODELA, RYAN JOSEPH (DPM)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JOSEPH
Last Name:RODELA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5471 GEORGETOWN RD STE C
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5794
Mailing Address - Country:US
Mailing Address - Phone:317-297-0661
Mailing Address - Fax:317-328-6338
Practice Address - Street 1:2230 STAFFORD RD STE 145
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2793
Practice Address - Country:US
Practice Address - Phone:317-856-8866
Practice Address - Fax:317-856-2312
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-08
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001371A213ES0103X, 213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program