Provider Demographics
NPI:1588993406
Name:LAPORTE ANESTHESIOLOGY, PC
Entity type:Organization
Organization Name:LAPORTE ANESTHESIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:WOLF
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:219-324-2229
Mailing Address - Street 1:800 LINCOLNWAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3439
Mailing Address - Country:US
Mailing Address - Phone:219-324-2229
Mailing Address - Fax:219-324-2229
Practice Address - Street 1:800 LINCOLNWAY
Practice Address - Street 2:SUITE 301
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3439
Practice Address - Country:US
Practice Address - Phone:219-324-2229
Practice Address - Fax:219-324-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038860A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100164970Medicaid
IN487880OtherMEDICARE