Individual
DAVID L TETRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9669 E 146TH ST, SUITE 310, NOBLESVILLE, IN 46060-5005
(317) 621-6170
(317) 621-6177
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
(317) 621-6180
(317) 621-6177
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01035208A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000659374
ANTHEM
IN
01
—
000000659797
ANTHEM
IN
05
—
100335770
—
IN
Enumeration date
07/27/2006
Last updated
11/27/2023
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