Provider Demographics
NPI:1902210560
Name:ASPESI, ANTHONY VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:VINCENT
Last Name:ASPESI
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 1:707 CEDAR ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:234 CHAPIN ST STE I
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-2571
Practice Address - Country:US
Practice Address - Phone:574-335-8250
Practice Address - Fax:574-335-0778
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-14656207Q00000X
NMMD2017-0499207Q00000X
IN11017640A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300054338Medicaid
IN1102273082OtherANTHEM
IN300054338Medicaid