Individual provider Active NPI

Dean Wundrach, MD

  • Student in an Organized Health Care Education/Training Program
  • Indianapolis, IN
National Provider Identifier
1932727211
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
License
11024308A Issued in IN
Practice address
7165 Clearvista Way
Indianapolis, IN 46256-4621
Phone
(317) 621-5700
Fax
(317) 621-7896
NPI assigned
Jul 13, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Technician/Technologist 156F00000X
Student in an Organized Health Care Education/Training Program 390200000X 11024308A IN Primary

Addresses

Primary practice location

7165 Clearvista Way
Indianapolis, IN 46256-4621

Mailing address

7165 Clearvista Way
Indianapolis, IN 46256-4621
Phone (317) 621-5700

Other practice location 1

32100 Telegraph Rd Ste 205
Bingham Farms, MI 48025-2454
Phone (248) 712-4266

Other identifiers 1

IdentifierTypeStateIssuer
300113343MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250604002285 IN Order and Referring Only - PsychiatryPractitioner - Psychiatry 3476062050

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Interoperability endpoints

  • Direct secure messaging: dwundrach649938@ecommunitydirect.com

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594598400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1932727211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7165 CLEARVISTA WAY",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462564621",
            "telephone_number": "317-621-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7165 CLEARVISTA WAY",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462564621",
            "telephone_number": "317-621-5700",
            "fax_number": "317-621-7896"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "32100 Telegraph Rd Ste 205",
            "address_purpose": "LOCATION",
            "city": "Bingham Farms",
            "state": "MI",
            "postal_code": "480252454",
            "country_code": "US",
            "telephone_number": "248-712-4266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WUNDRACH",
        "first_name": "DEAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-13",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156F00000X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IN",
            "license": "11024308A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "300113343",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.