Provider Demographics
NPI:1053311001
Name:ASDELL, TESSA M (MD)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:M
Last Name:ASDELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:M
Other - Last Name:ANTOLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
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:
Mailing Address - Fax:
Practice Address - Street 1:533 E COUNTY LINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1048
Practice Address - Country:US
Practice Address - Phone:317-497-6626
Practice Address - Fax:317-887-4691
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043684A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01588215OtherRR MEDICARE
INP00109136OtherRAILROAD MEDICARE
IN000000229539OtherANTHEM
IN0005624041OtherAETNA
IN200072050Medicaid
ING10555Medicare UPIN
IN266180623Medicare PIN
IN000000229539OtherANTHEM
IN266140Medicare PIN