Provider Demographics
NPI:1629058698
Name:AINSWORTH, MICHAEL E (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:E
Last Name:AINSWORTH
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 1:955 HIGH ST
Mailing Address - Street 2:STE 2
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-2326
Mailing Address - Country:US
Mailing Address - Phone:260-724-8700
Mailing Address - Fax:260-728-3821
Practice Address - Street 1:955 HIGH ST
Practice Address - Street 2:STE 2
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-2326
Practice Address - Country:US
Practice Address - Phone:260-724-8700
Practice Address - Fax:260-728-3821
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045263207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000093861OtherANTHEM
080154119OtherRAILROAD MEDICARE
IN200040480AMedicaid
IN200040480AMedicaid
000000093861OtherANTHEM