Healthcare Provider Details

I. General information

NPI: 1982616348
Provider Name (Legal Business Name): HEIDI M BAGWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEIDI M MIDDENDORF BAGWELL MD

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 S STATE ROAD 135 STE 330
GREENWOOD IN
46143-9825
US

IV. Provider business mailing address

1711 S STATE ROAD 135 SUITE C
GREENWOOD IN
46143-6480
US

V. Phone/Fax

Practice location:
  • Phone: 317-497-2400
  • Fax: 317-497-2515
Mailing address:
  • Phone: 317-881-7400
  • Fax: 317-881-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01060982A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: