MEDICARE: STINA WEDLOCK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	01048857A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417995135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STINA WEDLOCK MD

Provider Business Mailing Address
First Line	:	30 W RAMPART ST STE 200
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8846
Country	:	US
Telephone Number	:	317-421-2012
Fax Number	:	317-398-1851

Provider Business Practice Location Address
First Line	:	2451 INTELLIPLEX DR STE 260
Second Line	:
City	:	SHELBYVILLE
State	:	IN
Zip	:	46176-8580
Country	:	US
Telephone Number	:	317-398-0121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	09/09/2020

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Directions to “ STINA WEDLOCK MD” Practice Location

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