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NPI Code Detail

MEDICARE: DREW THOMAS DEISER

MEDICARE: DREW THOMAS DEISER
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
12255A2300XAthletic TrainerIN

General Provider Information

NPI Number : 1568192623
Entity Type Code : Individual
Provider Name (Legal Business Name) : DREW THOMAS DEISER
Provider Business Mailing Address
First Line : 1400 E HANNA AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-3697
Country : US
Telephone Number : 317-788-3368
Fax Number :
Provider Business Practice Location Address
First Line : 1400 E HANNA AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-3697
Country : US
Telephone Number : 317-788-3368
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2022
Last Update Date : 06/13/2022

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Directions to “ DREW THOMAS DEISER ” Practice Location

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