Healthcare Provider Details

I. General information

NPI: 1528000205
Provider Name (Legal Business Name): MARK E BELISLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 05/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 GATEWAY BLVD THE WOMENS HOSPITAL
NEWBURGH IN
47630
US

IV. Provider business mailing address

PO BOX 637275
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 812-842-4200
  • Fax:
Mailing address:
  • Phone: 812-473-0181
  • Fax: 812-473-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01027503A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: