Provider Demographics
NPI:1316959695
Name:DEMIR, TEOMAN R (MD)
Entity type:Individual
Prefix:DR
First Name:TEOMAN
Middle Name:R
Last Name:DEMIR
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 1:10110 DONALD POWERS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2915
Mailing Address - Country:US
Mailing Address - Phone:219-922-0222
Mailing Address - Fax:219-922-8899
Practice Address - Street 1:10110 DONALD POWERS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2915
Practice Address - Country:US
Practice Address - Phone:219-922-0222
Practice Address - Fax:219-922-8899
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050109A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200222040Medicaid
IN000000304901OtherANTHEM/BCBS
INP000096383OtherRRMEDICARE
IN168090EMedicare ID - Type Unspecified
INP000096383OtherRRMEDICARE