Provider Demographics
NPI:1881799179
Name:HARDESTY, WILLIAM P (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:P
Last Name:HARDESTY
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 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-485-2580
Mailing Address - Fax:812-485-2590
Practice Address - Street 1:1750 OAK HILL RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47711-4364
Practice Address - Country:US
Practice Address - Phone:812-485-2580
Practice Address - Fax:812-485-2590
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027451A207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100337380Medicaid
IN100337380Medicaid
IN351860CMedicare ID - Type Unspecified
IN110200873Medicare ID - Type UnspecifiedRR MCARE #