Individual
DOUGLAS MICHAEL DUNCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2403 LOY DR, LAFAYETTE, IN 47909-2701
(765) 448-8000
(765) 446-4351
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
01045408A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000188800
ANTHEM PROVIDER NUMBER
IN
01
—
10825030
CAQH NUMBER
IN
05
—
200075990
—
IN
01
—
9274774
PHCS PID NUMBER
IN
Enumeration date
03/14/2006
Last updated
02/02/2021
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