Healthcare Provider Details

I. General information

NPI: 1871598235
Provider Name (Legal Business Name): DONALD R. WESTERHAUSEN JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 ST FRANCIS WAY STE 205
LAFAYETTE IN
47905-4939
US

IV. Provider business mailing address

3900 ST FRANCIS WAY STE 205
LAFAYETTE IN
47905-4939
US

V. Phone/Fax

Practice location:
  • Phone: 765-428-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01041322A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number01041322A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: