Provider Demographics
NPI:1992770127
Name:HASTETTER, THOMAS STEPHAN (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:STEPHAN
Last Name:HASTETTER
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 1:7145 E VIRGINIA ST STE 2000
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-9147
Mailing Address - Country:US
Mailing Address - Phone:812-962-7894
Mailing Address - Fax:812-476-7117
Practice Address - Street 1:7145 E VIRGINIA ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-9147
Practice Address - Country:US
Practice Address - Phone:812-962-7890
Practice Address - Fax:812-476-6162
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01040195207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100180740Medicaid
IN100180740Medicaid