Provider Demographics
NPI:1134171168
Name:SANDQUIST, DEAN S (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:S
Last Name:SANDQUIST
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:PO BOX 32
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-0032
Mailing Address - Country:US
Mailing Address - Phone:812-254-2760
Mailing Address - Fax:812-254-8636
Practice Address - Street 1:1314 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2120
Practice Address - Country:US
Practice Address - Phone:812-254-2760
Practice Address - Fax:812-254-8636
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033843207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200041720Medicaid
IN220018913OtherRAILROAD MEDICARE
IN000000094093OtherANTHEM
IN220018913OtherRAILROAD MEDICARE
F01355Medicare UPIN
IN000000094093OtherANTHEM