Individual
ERIC A NISSWANDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3844 1ST AVE, EVANSVILLE, IN 47710-3326
(812) 428-6161
(812) 421-2883
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(812) 450-6815
(812) 450-6822
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01055787A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000265532
BCBS
IN
Enumeration date
03/16/2006
Last updated
07/08/2007
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