Individual
JOSEPH LEONARD DESTEFANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1116 N 16TH ST, LAFAYETTE, IN 47904-2119
(765) 423-6300
(765) 423-6301
Mailing address
1040 SIERRA DR, SUITE 400 ATTN: MARY DEAN, GREENWOOD, IN 46143-7240
(317) 865-8797
(317) 859-8552
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01042109A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200080730
—
IN
05
—
201069420L
—
IN
Enumeration date
04/14/2009
Last updated
12/28/2016
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