Provider Demographics
NPI:1356342810
Name:BIELAWSKI, MARTIN JOSEPH
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:JOSEPH
Last Name:BIELAWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 E COUNTY LINE RD
Mailing Address - Street 2:COMMUNITY HOSPITAL SOUTH HEALTHY HEARTS CLINIC
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-0963
Mailing Address - Country:US
Mailing Address - Phone:317-887-7988
Mailing Address - Fax:317-317-4972
Practice Address - Street 1:1402 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0963
Practice Address - Country:US
Practice Address - Phone:317-887-7988
Practice Address - Fax:317-497-2513
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000310A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300069639Medicaid
IN200194300Medicaid
066980PMedicare ID - Type Unspecified