Provider Demographics
NPI:1215938600
Name:DEITSCH, HOWARD C (MD)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:C
Last Name:DEITSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 N J ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1913
Mailing Address - Country:US
Mailing Address - Phone:765-935-3151
Mailing Address - Fax:765-935-7487
Practice Address - Street 1:1130 N J ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1913
Practice Address - Country:US
Practice Address - Phone:765-935-3151
Practice Address - Fax:765-935-7487
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01025101A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100139380AMedicaid
IN903660Medicare PIN
B29747Medicare UPIN