Provider Demographics
NPI:1225065188
Name:WISCHMEYER, RALPH L (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:L
Last Name:WISCHMEYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 SYCAMORE CT.
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47203-1545
Mailing Address - Country:US
Mailing Address - Phone:812-265-5211
Mailing Address - Fax:812-265-0570
Practice Address - Street 1:3220 SYCAMORE CT.
Practice Address - Street 2:SUITE 1B
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47203-1545
Practice Address - Country:US
Practice Address - Phone:812-265-5211
Practice Address - Fax:812-265-0570
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044780207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1096331OtherPASSPORT KY MEDICAID
IN200104870AMedicaid
IN415832POtherSIHO
050054407OtherMEDICARE RAILROAD
5187499OtherAETNA
KY64881147Medicaid
IN000000042212OtherANTHEM BCBS
KY2436126000OtherPASSPORT ADVANTAGE
F47686Medicare UPIN
IN412920BMedicare ID - Type Unspecified