Provider Demographics
NPI:1871598235
Name:WESTERHAUSEN, DONALD R JR (MD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:R
Last Name:WESTERHAUSEN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 ST FRANCIS WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-4939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3900 ST FRANCIS WAY STE 205
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4939
Practice Address - Country:US
Practice Address - Phone:765-428-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-14
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041322A207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000694301OtherANTHEM
IN100327930Medicaid
A13776Medicare UPIN
INP01012020 RR MEDMedicare PIN
IN184220JMedicare ID - Type Unspecified
IN100327930Medicaid
IN100327930AMedicaid