Provider Demographics
NPI:1033137476
Name:DAWALT, JOSHUA (DO)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:DAWALT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:317-621-9312
Mailing Address - Fax:
Practice Address - Street 1:7439 WOODLAND DR
Practice Address - Street 2:STE 105
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46278-1765
Practice Address - Country:US
Practice Address - Phone:317-644-5100
Practice Address - Fax:317-644-5101
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002880A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201018480Medicaid
IN000000715195OtherANTHEM
INP01347694OtherRAIL ROAD MEDICARE
IN201018480Medicaid
IN000000715195OtherANTHEM