Provider Demographics
NPI:1437335494
Name:INDIANA HEART AND VASCULAR INSTITUTE PC
Entity Type:Organization
Organization Name:INDIANA HEART AND VASCULAR INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:ESPAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-874-1400
Mailing Address - Street 1:1225 E COOLSPRING AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-6312
Mailing Address - Country:US
Mailing Address - Phone:219-861-8170
Mailing Address - Fax:219-871-7520
Practice Address - Street 1:1225 E COOLSPRING AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-6312
Practice Address - Country:US
Practice Address - Phone:219-861-8170
Practice Address - Fax:219-871-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-21
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041339A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000552910OtherANTHEME BC/BS
IN200890550AMedicaid
IN200890550AMedicaid
INDH0241Medicare PIN