Individual
DR. JON LEE STOCKRAHM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
2223 WABASH AVE, TERRE HAUTE, IN 47807-3305
(812) 235-7252
(812) 235-7176
Mailing address
2223 WABASH AVE, TERRE HAUTE, IN 47807-3305
(812) 235-7252
(812) 235-7176
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02002047
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000211750
ANTHEM
IN
01
—
110232365
RAILROAD MEDICARE
IN
05
—
200227720A
—
IN
01
—
5902718
AETNA
IN
Enumeration date
06/30/2005
Last updated
12/03/2024
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