Healthcare Provider Details

I. General information

NPI: 1235542101
Provider Name (Legal Business Name): PETER H BAENZIGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2014
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8424 NAAB RD STE 1H
INDIANAPOLIS IN
46260-1954
US

IV. Provider business mailing address

8424 NAAB RD STE 1H
INDIANAPOLIS IN
46260-1954
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-8680
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11017673A.
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number01078975A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: