Individual
DR. ECKHART DIESTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1855 S MAIN ST STE A, GOSHEN, IN 46526-4845
(574) 533-7476
(574) 533-7145
Mailing address
1505 S MAIN ST, GOSHEN, IN 46526-4719
(574) 364-2875
(574) 364-2784
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01047079A
IN
207RC0000X
Cardiovascular Disease Physician
01047079A
IN
207RI0011X
Interventional Cardiology Physician
Primary
01047079A
IN
207RI0011X
Interventional Cardiology Physician
13525
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000256560
BLUE CROSS
HI
05
—
201207610
—
IN
05
—
575508
—
HI
01
—
852791
ANTHEM
IN
Enumeration date
06/26/2006
Last updated
03/25/2014
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