Provider Demographics
NPI:1073783627
Name:DR HOUSECALL
Entity Type:Organization
Organization Name:DR HOUSECALL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALBRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-645-6303
Mailing Address - Street 1:4008 E NEW YORK ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-3662
Mailing Address - Country:US
Mailing Address - Phone:317-645-6303
Mailing Address - Fax:317-848-1922
Practice Address - Street 1:4008 E NEW YORK ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-3662
Practice Address - Country:US
Practice Address - Phone:317-645-6303
Practice Address - Fax:317-848-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064701A207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4921302Medicaid
MI4921302Medicaid
MIM40150144Medicare Oscar/Certification