Healthcare Provider Details

I. General information

NPI: 1831173186
Provider Name (Legal Business Name): WILLIAM JENKINS SPANENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

931 12 OAKS
CARMEL IN
46032-9432
US

IV. Provider business mailing address

931 12 OAKS
CARMEL IN
46032-9432
US

V. Phone/Fax

Practice location:
  • Phone: 317-417-7404
  • Fax:
Mailing address:
  • Phone: 317-417-7404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01048277A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: