Individual
TERRY ALLEN IWASKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1011 MAIN ST STE 110, INDIANAPOLIS, IN 46224-6978
(317) 957-9150
(317) 957-9965
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02001352
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000793981
BCBS
IN
05
—
100360790
—
IN
01
—
P01424409
RAIL ROAD PTAN
IN
Enumeration date
10/11/2006
Last updated
04/18/2022
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