Provider Demographics
NPI:1851311922
Name:WISH, JAY B (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:B
Last Name:WISH
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 1:250 N SHADELAND AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1228
Practice Address - Country:US
Practice Address - Phone:317-944-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-043263207RN0300X
IN01073447A207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH364142OtherWELLCARE
OH000000539618OtherANTHEM
OH0640748OtherAETNA
IN201206880Medicaid
OH741808OtherBUCKEYE
OH0399304Medicaid
OH10001166OtherRAILROAD MEDICARE
OH000000224359OtherUNISON
OHP00449244OtherRAILROAD MEDICARE
OH364142OtherWELLCARE
OHWI0465992Medicare PIN
OH0399304Medicaid
WI0465995Medicare PIN