Healthcare Provider Details

I. General information

NPI: 1790304632
Provider Name (Legal Business Name): PATRICK DONALD WURSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8244 E US HIGHWAY 36 STE 200
AVON IN
46123-9621
US

IV. Provider business mailing address

1100 SOUTHFIELD DR STE 1370
PLAINFIELD IN
46168-4300
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-4242
  • Fax: 317-272-6640
Mailing address:
  • Phone: 317-837-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number01097110
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: