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General NPI Number Information
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NPI Number | 1073590675
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Entity Type | Individual
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Provider Name | BRYAN R WIPPERMAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/27/2005
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 416 E MONROE ST SUITE 200
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City | SOUTH BEND
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State | IN
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Zip | 46601-2360
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Country | US
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Telephone | 574-232-8119
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Fax | 574-288-0235
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Provider Business Mailing Address
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Address Line | 416 E MONROE ST SUITE 200
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City | SOUTH BEND
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State | IN
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Zip | 46601-2360
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Country | US
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Telephone | 574-232-8119
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Fax | 574-288-0235
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 01031311
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License Number State | IN
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