Provider Demographics
NPI:1942468988
Name:TISCH, DONNA (MD)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:TISCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1130 MEDICAL ARTS BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-3432
Practice Address - Country:US
Practice Address - Phone:765-298-4282
Practice Address - Fax:765-298-4989
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01070059A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201027030Medicaid
INP01292385OtherRAILROAD MEDICARE
INP01292385OtherRAILROAD MEDICARE