Organization
INTERNAL MEDICINE OF THE WABASH VALLEY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JON LEE STOCKRAHM D.O., CMD (PRESIDENT)
(812) 235-7252
Entity
Organization
Contact information
Practice address
2223 WABASH AVE, TERRE HAUTE, IN 47807-3305
(812) 235-7252
(812) 235-7176
Mailing address
1600 E SPRINGHILL DR, TERRE HAUTE, IN 47802-4363
(812) 235-7252
(812) 235-7176
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02002047
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200227720A
—
IN
Enumeration date
08/03/2015
Last updated
12/03/2024
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