Provider Demographics
NPI:1558533935
Name:THOMAS C. WISLER, SR., M.D., LLC
Entity Type:Organization
Organization Name:THOMAS C. WISLER, SR., M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CRITSER
Authorized Official - Suffix:
Authorized Official - Credentials:CREDENTIALING SPECIA
Authorized Official - Phone:317-422-5490
Mailing Address - Street 1:7830 MCFARLAND LN
Mailing Address - Street 2:STE. B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-4705
Mailing Address - Country:US
Mailing Address - Phone:317-889-6551
Mailing Address - Fax:317-422-8430
Practice Address - Street 1:7830 MCFARLAND LN
Practice Address - Street 2:STE. B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-4705
Practice Address - Country:US
Practice Address - Phone:317-889-6551
Practice Address - Fax:317-422-8430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029384A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN559579OtherANTHEM GROUP
IN559581OtherANTHEM INDIVIDUAL
IN100064260AMedicaid
IN1104816271OtherINDIVIDUAL NPI
IN559581OtherANTHEM INDIVIDUAL
IND94566Medicare UPIN