Healthcare Provider Details

I. General information

NPI: 1174500474
Provider Name (Legal Business Name): WILLIAM G TERPSTRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N DIXON RD
KOKOMO IN
46901-1754
US

IV. Provider business mailing address

605 E 7TH ST PO BOX 38
BURLINGTON IN
46915-9441
US

V. Phone/Fax

Practice location:
  • Phone: 765-452-0878
  • Fax: 765-452-1826
Mailing address:
  • Phone: 765-566-3351
  • Fax: 765-566-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01025462
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: