Provider Demographics
NPI:1528862588
Name:TERRE HAUTE ENDOCRINOLOGY AND DIABETES LLC
Entity type:Organization
Organization Name:TERRE HAUTE ENDOCRINOLOGY AND DIABETES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:RICO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-912-8457
Mailing Address - Street 1:3681 N EGAN ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47805-9743
Mailing Address - Country:US
Mailing Address - Phone:847-912-8457
Mailing Address - Fax:
Practice Address - Street 1:2235 WABASH AVE
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47807-3330
Practice Address - Country:US
Practice Address - Phone:847-912-8457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty