Provider Demographics
NPI:1861415416
Name:CLEMENTS, ROBERT E (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:CLEMENTS
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 1:10935 RIDGE COURT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-9674
Mailing Address - Country:US
Mailing Address - Phone:317-849-6924
Mailing Address - Fax:217-849-2413
Practice Address - Street 1:10935 RIDGE COURT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-9674
Practice Address - Country:US
Practice Address - Phone:317-849-6924
Practice Address - Fax:217-849-2413
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025322A207Q00000X
IN01025322207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00072546OtherRR MEDICARE
IN100127490Medicaid
IN000000312979OtherANTHEM
IN100127490Medicaid
INB28733Medicare UPIN
IN214220AMedicare PIN