Individual
ANGELA FAYE DEWEESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
545 S BOEHNE CAMP RD, EVANSVILLE, IN 47712-3703
(812) 429-1818
(812) 426-9564
Mailing address
PO BOX 3868, EVANSVILLE, IN 47737-3868
(812) 429-1818
(812) 426-9564
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01047130A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000318862
ANTHEM
IN
05
—
200116780
—
IN
01
—
64075823
KY MEDICAID
KY
Enumeration date
12/01/2006
Last updated
01/03/2013
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