Provider Demographics
NPI:1609899079
Name:WESLEY, PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WESLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-621-6808
Mailing Address - Fax:317-621-6808
Practice Address - Street 1:11911 N MERIDIAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6919
Practice Address - Country:US
Practice Address - Phone:317-621-6800
Practice Address - Fax:317-621-6808
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034472A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100335520Medicaid
IN000000313304OtherANTHEM
INP00102144OtherRR MEDICARE
IND46938Medicare UPIN
INP00102144OtherRR MEDICARE
IN100335520Medicaid