Organization
WESTSIDE GYNECOLOGY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOSUE J VILLALTA MD (PRESIDENT)
(317) 329-7177
Entity
Organization
Contact information
Practice address
6920 PARKDALE PL, SUITE 100, INDIANAPOLIS, IN 46254-5612
(317) 329-7177
(317) 329-7180
Mailing address
6920 PARKDALE PL, SUITE 100, INDIANAPOLIS, IN 46254-5612
(317) 329-7177
(317) 329-7180
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
01029614A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000093399
BLUE SHIELD NUMBER
IN
Enumeration date
10/10/2006
Last updated
08/22/2020
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