Healthcare Provider Details

I. General information

NPI: 1467472753
Provider Name (Legal Business Name): EDWIN M EPPLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1542 S BLOOMINGTON ST
GREENCASTLE IN
46135-2297
US

IV. Provider business mailing address

250 N SHADELAND AVE SUITE 130 - PROVIDER ENROLLEMENT
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 765-301-7617
  • Fax: 765-301-7621
Mailing address:
  • Phone: 260-407-8000
  • Fax: 317-962-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01045296A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: