Deturk, Todd Lee

Deturk, Todd Lee is an individual health care provider with primary practice located at 7601 W Jefferson Blvd , Fort Wayne IN 46804-4133. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Deturk, Todd Lee can be contacted via phone (260) 436-8686.

Contact Information

Primary practice address
7601 W Jefferson Blvd Fort Wayne IN 46804-4133
Phone: (260) 436-8686
Fax: (260) 436-8585
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 10000810A Indiana

Profile Details

NPI number 1558332403
LBN Legal business name Deturk, Todd Lee
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 30th, 2006
Last updated Nov 7th, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1558332403 NPPES
Indiana MEDICAID OPR
Indiana Other 000000622050

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