Provider Demographics
NPI:1558356048
Name:WIPPERMANN, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:WIPPERMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1155 W JEFFERSON ST
Mailing Address - Street 2:STE 102
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-2730
Mailing Address - Country:US
Mailing Address - Phone:317-736-7603
Mailing Address - Fax:317-736-7932
Practice Address - Street 1:1155 W JEFFERSON ST
Practice Address - Street 2:STE 102
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-2730
Practice Address - Country:US
Practice Address - Phone:317-736-7603
Practice Address - Fax:317-736-7932
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2007-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01033537208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100350210AMedicaid
D69623Medicare UPIN