Healthcare Provider Details

I. General information

NPI: 1376602482
Provider Name (Legal Business Name): JONATHAN JAMES TRUCHAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 W 89TH AVE STE E1
MERRILLVILLE IN
46410-6295
US

IV. Provider business mailing address

9030 CLINE AVE
HIGHLAND IN
46322-2204
US

V. Phone/Fax

Practice location:
  • Phone: 219-736-8915
  • Fax: 219-736-8928
Mailing address:
  • Phone: 219-736-8915
  • Fax: 219-736-8928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000937A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: