Provider Demographics
NPI:1366490641
Name:TIERNEY, WILLIAM M (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:TIERNEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:410 W 10TH ST
Mailing Address - Street 2:SUITE HS2000
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3010
Mailing Address - Country:US
Mailing Address - Phone:317-630-7660
Mailing Address - Fax:317-630-2466
Practice Address - Street 1:1002 WISHARD BLVD
Practice Address - Street 2:4TH FL
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2872
Practice Address - Country:US
Practice Address - Phone:317-692-2323
Practice Address - Fax:317-656-3967
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2012-02-01
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Provider Licenses
StateLicense IDTaxonomies
IN01027180A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200478510Medicaid
IN200478510Medicaid
INI17971Medicare UPIN