Individual
DR. EDWARD J BASTYR III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
720 ESKENAZI AVE, UNIVERSITY MEDICAL DIAGNOSTIC ASSOCIATES, INC., INDIANAPOLIS, IN 46202-5166
(317) 880-5045
(317) 880-0414
Mailing address
250 N SHADELAND AVE., SUITE 130, INDIANAPOLIS, IN 46219-4959
(317) 823-9357
(317) 823-9357
Taxonomy
Speciality
Code
Description
License number
State
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
01044193A
IN
282N00000X
General Acute Care Hospital
01044193A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201291380
—
IN
Enumeration date
11/30/2006
Last updated
12/28/2020
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