Provider Demographics
NPI:1275649345
Name:WESEMANN MEDICAL SERVICE INC.
Entity Type:Organization
Organization Name:WESEMANN MEDICAL SERVICE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MERRILL
Authorized Official - Middle Name:MAX
Authorized Official - Last Name:WESEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-736-6121
Mailing Address - Street 1:251 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131
Mailing Address - Country:US
Mailing Address - Phone:317-736-6121
Mailing Address - Fax:317-736-9811
Practice Address - Street 1:251 E JEFFERSON
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131
Practice Address - Country:US
Practice Address - Phone:317-736-6121
Practice Address - Fax:317-736-9811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN19510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D94819Medicare UPIN
IN431330AMedicare PIN