Provider Demographics
NPI:1316140809
Name:INDIANAPOLIS INTERNAL MEDICINE
Entity type:Organization
Organization Name:INDIANAPOLIS INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WISLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-889-6551
Mailing Address - Street 1:7830 MCFARLAND LN
Mailing Address - Street 2:STE. B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-4705
Mailing Address - Country:US
Mailing Address - Phone:317-889-6551
Mailing Address - Fax:317-889-6651
Practice Address - Street 1:7830 MCFARLAND LN
Practice Address - Street 2:STE. B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-4705
Practice Address - Country:US
Practice Address - Phone:317-889-6551
Practice Address - Fax:317-889-6651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045434A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1649387028OtherPROVIDER NPI
IN358437OtherANTHEM/BCBS
IN200142090CMedicaid
ING60719Medicare UPIN
IN1649387028OtherPROVIDER NPI