Provider Demographics
NPI:1295771244
Name:HANKE, CARL WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:WILLIAM
Last Name:HANKE
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 1:8925 N MERIDIAN ST STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2385
Mailing Address - Country:US
Mailing Address - Phone:317-660-4900
Mailing Address - Fax:317-660-7112
Practice Address - Street 1:8925 N MERIDIAN ST STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2385
Practice Address - Country:US
Practice Address - Phone:317-660-4900
Practice Address - Fax:317-660-7112
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18628207ND0101X, 207NS0135X
IN01029310A207ND0900X, 207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0735829Medicaid
IN10062850AMedicaid
IA10702OtherWELLMARK BCBS
IN10062850AMedicaid
IA10702OtherWELLMARK BCBS
C24350Medicare UPIN