Carole Ann Derucki in South Bend - Specialist
Carole Ann Derucki - NPI 1205809225
Carole Ann Derucki is a Specialist in South Bend, Indiana. Carole Ann Derucki practices all healthcare services and medical treatments related to Specialist. The NPI Number for Carole Ann Derucki is 1205809225. The last update date is 2016-09-14.
Carole Ann Derucki's current location address is 707 E Cedar St, South Bend, Indiana. You can contact this provider via phone number 5744726700 and fax number 5743350760. The mailing address for Carole Ann Derucki is 707 E Cedar St, South Bend, Indiana. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Carole Ann Derucki |
|---|---|
| Address | 707 E Cedar St, South Bend, Indiana |
| Phone Number | 5744726700 |
| Fax Number | 5743350760 |
| Sole Proprietor | N |
| Credentials | CN-P |
NPI Number Detail
| NPI Number | 1205809225 |
|---|---|
| Provider Enumeration Date | 2006-02-09 |
| Last Updated Date | 2016-09-14 |
Provider Mailing Address Detail
| Address | 707 E Cedar St |
|---|---|
| City | South Bend |
| State | Indiana (IN) |
| Post Code | 466172057 |
| Phone Number | 5744726700 |
| Fax Number | 5743350760 |
Provider's Primary Taxonomy Detail
| Speciality | Specialist |
|---|---|
| Taxonomy | 174400000X |
| Licence No | 71002723A |
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Definition: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 723347 | IN | BCBS | |
| 200917690 | IN | -- | |
| 200917690A | IN | -- | |
| 4704166108 | MI | MICHIGAN | |
| 478536310 | MI | -- |
Post Comment/ Review Below
What is the unique identifier code issued to Carole Ann Derucki by the Centers for Medicare & Medicaid Services (CMS)?
The Carole Ann Derucki has been assigned the NPI (National Provider Identifier) 1205809225. This 10-digit code serves as a unique identification number for healthcare providers, issued by the CMS.
Where is the Carole Ann Derucki located?
The Carole Ann Derucki is located at 707 E Cedar St, South Bend, IN 466172057.
What is the Carole Ann Derucki's area of specialization and corresponding taxonomy classification?
The Carole Ann Derucki's specialty field is Specialist, and it falls under the taxonomy code 174400000X, which categorizes healthcare providers based on their specialties.
On what date did the Centers for Medicare & Medicaid Services assign the 1205809225 to Carole Ann Derucki?
The Centers for Medicare & Medicaid Services assigned the 1205809225 to Carole Ann Derucki on 2006-02-09.
As of what date were the details related to Carole Ann Derucki most recently updated or revised?
The information pertaining to Carole Ann Derucki, including its address, specialty, and other relevant details, was last updated or revised on 2016-09-14.