Provider Demographics
NPI:1902038060
Name:ORTUZAR, WALDO I (MD)
Entity Type:Individual
Prefix:DR
First Name:WALDO
Middle Name:I
Last Name:ORTUZAR
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 1:13869 KICKAPOO TR.
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-8545
Mailing Address - Country:US
Mailing Address - Phone:317-433-0280
Mailing Address - Fax:317-277-3238
Practice Address - Street 1:13869 KICKAPOO TR.
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8545
Practice Address - Country:US
Practice Address - Phone:317-433-0280
Practice Address - Fax:317-277-3238
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-21
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01066109A207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology