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NPI Code Detail

MEDICARE: MR. TED J WESTLUND PA

MEDICARE: MR. TED J WESTLUND PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician Assistant10000142AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
110000142AOTHERINSTATE LICENSE

General Provider Information

NPI Number : 1275874497
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TED J WESTLUND PA
Provider Business Mailing Address
First Line : 8805 N MERIDIAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2760
Country : US
Telephone Number : 317-706-7246
Fax Number : 317-706-3419
Provider Business Practice Location Address
First Line : 8805 N MERIDIAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-2760
Country : US
Telephone Number : 317-706-7246
Fax Number : 317-706-3419
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2013
Last Update Date : 07/07/2016

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