Individual
DONALD SQUIRES DUNEVANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3630 WILLOWCREEK RD, PORTAGE, IN 46368-5075
(219) 759-5791
(219) 759-3807
Mailing address
3630 WILLOWCREEK RD, PORTAGE, IN 46368-5075
(219) 759-1157
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01033863
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000522003
ANTHEM
IN
01
—
080106826
RAILROAD
IN
05
—
100188440A
—
IN
01
—
5251392
AETNA
—
Enumeration date
03/28/2006
Last updated
05/16/2019
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