Provider Demographics
NPI:1962439893
Name:DEYMANN, ANDREAS J (MD)
Entity Type:Individual
Prefix:
First Name:ANDREAS
Middle Name:J
Last Name:DEYMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-274-1201
Mailing Address - Fax:317-278-9905
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:ROC 4270
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-278-7738
Practice Address - Fax:317-274-7227
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN010623622080P0203X, 207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200827870Medicaid
IN000000947991OtherBCBS MEMORIAL CHILDREN'S HOSPITAL
IN000000947991OtherBCBS MEMORIAL CHILDREN'S HOSPITAL
F70792Medicare UPIN