| Mr Phillip T Deturk, NP | |
|
124 Sagamore Pkwy West, West Lafayette, IN 47906 | |
| (765) 463-6722 | |
| (765) 463-0905 |
| Full Name | Mr Phillip T Deturk |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner |
| Experience | 19 Years |
| Location | 124 Sagamore Pkwy West, West Lafayette, Indiana |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275626095 | NPI | - | NPPES |
| 71002161A | Other | IN | NURSE PRACTITIONER AUTHOR |
| 28153076A | Other | IN | REGISTERED NURSE LICENSE |
| 71002161B | Other | IN | APN CSR REFERENCE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363L00000X | Nurse Practitioner | 71002161A (Indiana) | Primary |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Randall Dermatology, Pc | 3678675329 | 10 |
| Entity Name | Randall Dermatology, Pc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1245340488 PECOS PAC ID: 3678675329 Enrollment ID: O20070227000078 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Phillip T Deturk, NP 124 Sagamore Pkwy West, West Lafayette, IN 47906 Ph: (765) 463-6722 | Mr Phillip T Deturk, NP 124 Sagamore Pkwy West, West Lafayette, IN 47906 Ph: (765) 463-6722 |
Laura L Wavra, NP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 124 Sagamore Pkwy W, West Lafayette, IN 47906 Phone: 765-463-6722 Fax: 765-463-0905 | |
Marcia Ann Stroup, CRNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 253 Sagamore Pkwy W, West Lafayette, IN 47906 Phone: 765-448-8000 Fax: 765-448-8227 | |
Gayle Doll, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 512 Sagamore Pkwy W, West Lafayette, IN 47906 Phone: 765-497-3551 | |
Mrs. Stephanie L. Davitto, N.P. Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 124 Sagamore Pkwy West, West Lafayette, IN 47906 Phone: 765-463-6722 Fax: 765-463-0905 | |
Yun Cai, Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 601 Stadium Mall Dr, West Lafayette, IN 47907 Phone: 765-494-1700 | |
Azza H Ahmed, CPNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 502 N University St, West Lafayette, IN 47907 Phone: 765-494-4040 | |
Leslie D Lester, MWNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 601 Stadium Mall Dr, West Lafayette, IN 47907 Phone: 765-494-1700 Fax: 765-496-1227 |