Individual
TODD LEE DETURK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
(260) 436-8585
Mailing address
PO BOX 2526, FORT WAYNE, IN 46801-2526
(260) 436-8686
(260) 436-8585
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000810A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000622050
ANTHEM
—
05
—
OPR
—
IN
Enumeration date
01/30/2006
Last updated
11/07/2016
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