Provider Demographics
NPI:1275874497
Name:WESTLUND, TED J (PA)
Entity Type:Individual
Prefix:MR
First Name:TED
Middle Name:J
Last Name:WESTLUND
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:8805 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2760
Mailing Address - Country:US
Mailing Address - Phone:317-706-7246
Mailing Address - Fax:317-706-3419
Practice Address - Street 1:8805 N MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2760
Practice Address - Country:US
Practice Address - Phone:317-706-7246
Practice Address - Fax:317-706-3419
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000142A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN10000142AOtherSTATE LICENSE