Healthcare Provider Details

I. General information

NPI: 1558356048
Provider Name (Legal Business Name): DAVID R WIPPERMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 05/22/2024
Certification Date: 05/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

1155 W JEFFERSON ST STE 102
FRANKLIN IN
46131-2731
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 Code208600000X
TaxonomySurgery Physician
License Number01033537
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: