Healthcare Provider Details

I. General information

NPI: 1831892959
Provider Name (Legal Business Name): ROBERT PAUL BERWANGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W MICHIGAN ST RM 365
INDIANAPOLIS IN
46202-5209
US

IV. Provider business mailing address

2001 W 86TH ST
INDIANAPOLIS IN
46260-1902
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-0267
  • Fax:
Mailing address:
  • Phone: 317-338-6399
  • Fax: 317-338-6359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number11023577A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: