Basic Information
| Provider Information | |||||||||
| NPI: | 1023184090 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WABASH CARDIOLOGY, LLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 784 | ||||||||
| Address2: | |||||||||
| City: | VINCENNES | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475910784 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128826416 | ||||||||
| FaxNumber: | 8128828620 | ||||||||
| Practice Location | |||||||||
| Address1: | 406 N 1ST ST | ||||||||
| Address2: | |||||||||
| City: | VINCENNES | ||||||||
| State: | IN | ||||||||
| PostalCode: | 475911340 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128826416 | ||||||||
| FaxNumber: | 8128828620 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 07/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | BLEMKER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | GENERAL PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8128826416 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 01035286 | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.