Healthcare Provider Details

I. General information

NPI: 1699938134
Provider Name (Legal Business Name): DUSTEN ANDREW WESSEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2008
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 GATEWAY BLVD
NEWBURGH IN
47630-8900
US

IV. Provider business mailing address

PO BOX 3868
EVANSVILLE IN
47737-3868
US

V. Phone/Fax

Practice location:
  • Phone: 812-853-7391
  • Fax: 812-858-6460
Mailing address:
  • Phone: 812-853-7391
  • Fax: 812-858-6460

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2008018615
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02003885A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: