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Individual

EDWARD JOHN DIEKHOFF

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1375 W SMITH VALLEY RD, GREENWOOD, IN 46142-1540
(317) 859-6950
Mailing address
1375 W SMITH VALLEY RD, GREENWOOD, IN 46142-1540

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01039037A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000001722
MDWISE/PRO HEALTH ID
IN
01
000000351070
ANTHEM ID
IN
01
10813894
CAQH ID
IN
05
200019310
IN
01
4218208
AETNA ELIGIBILITY ID
IN
01
P00171329
MEDICARE RAILROAD ID
IN
01
P01157057
RR MEDICARE PTAN
IN
Enumeration date
05/31/2006
Last updated
01/02/2026
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