Provider Demographics
NPI:1386751931
Name:CORREA, JUAN J (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:J
Last Name:CORREA
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 1:221 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47807-4214
Mailing Address - Country:US
Mailing Address - Phone:812-242-3610
Mailing Address - Fax:812-242-3630
Practice Address - Street 1:1711 N 6 1/2 ST
Practice Address - Street 2:STE 200
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47804-2766
Practice Address - Country:US
Practice Address - Phone:812-242-3610
Practice Address - Fax:812-242-3630
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027664A207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000089646OtherANTHEM
INP00818705OtherRAILROAD MEDICARE
IN100250360Medicaid
000000089646OtherANTHEM
IN100250360Medicaid
IN301550DMedicare PIN
IN859910A5Medicare PIN
IN859920CMedicare PIN
IN780920DMedicare PIN
IN830001368Medicare PIN
IN900000540Medicare PIN
IN265130VVMedicare PIN