Individual
DEBRA JEAN MADURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5177 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
(765) 838-6302
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01040592A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000185174
ANTHEM PROVIDER NUMBER
IN
05
—
100199120
—
IN
01
—
10825517
CAQH NUMBER
IN
01
—
9027951
PHCS PID NUMBER
IN
05
—
MA618710HO
—
IN
Enumeration date
03/16/2006
Last updated
02/03/2021
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