Healthcare Provider Details

I. General information

NPI: 1225167901
Provider Name (Legal Business Name): DORENE G. HOJNICKI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 03/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 S PETERCHEFF ST
TERRE HAUTE IN
47803-5027
US

IV. Provider business mailing address

1812 E CRYSTAL CREEK DR
TERRE HAUTE IN
47802-4897
US

V. Phone/Fax

Practice location:
  • Phone: 812-462-3217
  • Fax:
Mailing address:
  • Phone: 812-299-9553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02001051
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: