Provider Demographics
NPI:1831173186
Name:SPANENBERG, WILLIAM JENKINS (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JENKINS
Last Name:SPANENBERG
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 1:931 12 OAKS
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9432
Mailing Address - Country:US
Mailing Address - Phone:317-417-7404
Mailing Address - Fax:
Practice Address - Street 1:931 12 OAKS
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-9432
Practice Address - Country:US
Practice Address - Phone:317-417-7404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048277A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200175090Medicaid
IN200175090Medicaid
IN940550RRMedicare PIN