Provider Demographics
NPI:1902846793
Name:HOSTETLER, DAWN R (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:R
Last Name:HOSTETLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:R
Other - Last Name:ANDRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
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 1:1375 N GREEN ST
Practice Address - Street 2:STE 100
Practice Address - City:BROWNSBURG
Practice Address - State:IN
Practice Address - Zip Code:46112-8734
Practice Address - Country:US
Practice Address - Phone:317-852-2251
Practice Address - Fax:317-852-1225
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01051243207Q00000X
IN01051243A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200233430Medicaid
INM400015402OtherMEDICARE PTAN
INM400015402Medicare PIN
ING94692Medicare UPIN
INP00844437Medicare PIN