Healthcare Provider Details

I. General information

NPI: 1124079496
Provider Name (Legal Business Name): JOANNA HWANG WATKINS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA HWANG M.D.

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/27/2024
Certification Date: 11/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 S MCINTIRE DR SUITE 350
BLOOMINGTON IN
47403-4221
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 812-332-7337
  • Fax: 812-339-2934
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number47798
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01071343A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA105519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: