Healthcare Provider Details

I. General information

NPI: 1356421895
Provider Name (Legal Business Name): DAVID R. WIPPERMANN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 W JEFFERSON ST SUITE 102
FRANKLIN IN
46131-2730
US

IV. Provider business mailing address

1155 W JEFFERSON ST SUITE 102
FRANKLIN IN
46131-2730
US

V. Phone/Fax

Practice location:
  • Phone: 317-736-7603
  • Fax: 317-736-7932
Mailing address:
  • Phone: 317-736-7603
  • Fax: 317-736-7932

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateIN

VIII. Authorized Official

Name: DR. DAVID R WIPPERMANN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 317-736-7603