Individual
DR. MARK A BISESI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
429 S LANDMARK AVE, BLOOMINGTON, IN 47403-5003
(812) 332-8242
(812) 333-7684
Mailing address
250 N SHADELAND AVE STE 200, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01041925A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200051060
—
IN
01
—
300072212
RR MEDICARE
IN
01
—
P00096530
RR MEDICARE
IN
Enumeration date
05/02/2006
Last updated
05/01/2023
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