Provider Demographics
NPI:1518940196
Name:ORDONEZ, OSCAR I (MD)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:I
Last Name:ORDONEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5091 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4486
Mailing Address - Country:US
Mailing Address - Phone:765-468-6337
Mailing Address - Fax:765-468-6536
Practice Address - Street 1:5091 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47303-4486
Practice Address - Country:US
Practice Address - Phone:765-468-6337
Practice Address - Fax:765-468-6536
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-28
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041437A207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL00432010OtherIL BC/BS #
OH0132056Medicaid
IL351889399OtherIL TRICARE #
IL036102486Medicaid
IN000000089346OtherPARKER CITY BC/BS
IN100211480Medicaid
IL592060Medicare ID - Type UnspecifiedIL MEDICARE #
IN000000089346OtherPARKER CITY BC/BS
IL00432010OtherIL BC/BS #
IN691420Medicare ID - Type UnspecifiedPARKER CITY #