Provider Demographics
NPI:1699783084
Name:HELDERMAN, TRINA (MD)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:
Last Name:HELDERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3019 W CULLOM AVE # 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-1309
Mailing Address - Country:US
Mailing Address - Phone:317-407-5105
Mailing Address - Fax:260-407-8004
Practice Address - Street 1:1501 HARTFORD ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2134
Practice Address - Country:US
Practice Address - Phone:765-423-6011
Practice Address - Fax:260-407-8004
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146D00000X
IN01062591A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000489652OtherANTHEM
IN200832830Medicaid
IN809640DDDDMedicare PIN
INP003851949Medicare PIN
IN226540ZMedicare PIN
IN200832830Medicaid