Basic Information
| Provider Information | |||||||||
| NPI: | 1255795001 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WESTERHAUSEN | ||||||||
| FirstName: | JILLIAN | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 SOUTHFIELD DR STE 1370 | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461684300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178375570 | ||||||||
| FaxNumber: | 3178375580 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 SATORI PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461236407 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172716363 | ||||||||
| FaxNumber: | 3172717600 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2016 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | IN | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | 02005772A | IN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.