Provider Demographics
NPI:1194734509
Name:WERTMAN, DANIEL E (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:E
Last Name:WERTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 N SENATE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3763
Mailing Address - Country:US
Mailing Address - Phone:317-715-6401
Mailing Address - Fax:317-715-6454
Practice Address - Street 1:550 UNIVERSITY BLVD
Practice Address - Street 2:RADIOLOGY DEPT
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5149
Practice Address - Country:US
Practice Address - Phone:317-278-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012319302085R0202X
IN010624982085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00742728OtherRAILROAD MEDICARE
IN000000556662OtherANTHEM BCBS
IN200844700Medicaid
INP00396800OtherRAILROAD MEDICARE
IN200844700Medicaid
INP00742728OtherRAILROAD MEDICARE