Individual
DR. PETER ROBERT ANSORGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
(765) 447-9749
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01070158A
IN
207Q00000X
Family Medicine Physician
5315031940
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000730470
ANTHEM PROVIDER NUMBER
IN
05
—
201032770
—
IN
Enumeration date
06/20/2007
Last updated
11/18/2020
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