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General NPI Number Information
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NPI Number | 1477505022
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Entity Type | Organization
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Legal Business Name | WISHARD ANESTHESIA GROUP, LLC
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 01/04/2021
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Provider Practice Location Address
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Address Line | 720 ESKENAZI AVE ANESTHESIA HG207
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5166
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Country | US
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Telephone | 317-880-5361
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Fax | 800-731-0699
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Provider Business Mailing Address
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Address Line | PO BOX 6069 DEPT 110
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-6069
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Country | US
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Telephone | 317-614-9850
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Fax | 800-731-0699
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN HASEWINKEL
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Credential | MD
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Telephone | 317-880-5361
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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 |
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License Number State | IN
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