Provider Demographics
NPI:1477505022
Name:WISHARD ANESTHESIA GROUP, LLC
Entity Type:Organization
Organization Name:WISHARD ANESTHESIA GROUP, LLC
Other - Org Name:ESKENAZI HEALTH
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HASEWINKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-880-5361
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:DEPT 110
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-6069
Mailing Address - Country:US
Mailing Address - Phone:317-614-9850
Mailing Address - Fax:800-731-0699
Practice Address - Street 1:720 ESKENAZI AVE
Practice Address - Street 2:ANESTHESIA HG207
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5166
Practice Address - Country:US
Practice Address - Phone:317-880-5361
Practice Address - Fax:800-731-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200007620Medicaid
IN248340Medicare PIN