Provider Demographics
NPI:1255673000
Name:RIGGS, CALLYN B (MD)
Entity type:Individual
Prefix:
First Name:CALLYN
Middle Name:B
Last Name:RIGGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CALLYN
Other - Middle Name:E
Other - Last Name:BRAUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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:317-948-2700
Mailing Address - Fax:317-948-2959
Practice Address - Street 1:1111 RONALD REAGAN PKWY
Practice Address - Street 2:B1100
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7085
Practice Address - Country:US
Practice Address - Phone:317-948-2700
Practice Address - Fax:317-948-2959
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01076545208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201177380Medicaid
IN145590127Medicare PIN