Provider Demographics
NPI:1265439921
Name:HILGENDORF, WILLIAM A (PHD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:HILGENDORF
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11725 N ILLINOIS ST
Practice Address - Street 2:STE 3501
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3008
Practice Address - Country:US
Practice Address - Phone:317-688-2647
Practice Address - Fax:317-688-2921
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040359A103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100337310BMedicaid
INP00831908OtherRAILROAD MEDICARE
IN100337310Medicaid
INM400072841Medicare PIN
INP00831908OtherRAILROAD MEDICARE
IN521150AMedicare PIN
IN100337310BMedicaid