Provider Demographics
NPI:1023184090
Name:WABASH CARDIOLOGY, LLP
Entity Type:Organization
Organization Name:WABASH CARDIOLOGY, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLEMKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-882-6416
Mailing Address - Street 1:PO BOX 784
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-0784
Mailing Address - Country:US
Mailing Address - Phone:812-882-6416
Mailing Address - Fax:812-882-8620
Practice Address - Street 1:406 N 1ST ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1340
Practice Address - Country:US
Practice Address - Phone:812-882-6416
Practice Address - Fax:812-882-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035286207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INE44303Medicare UPIN
IN069820Medicare ID - Type Unspecified