Healthcare Provider Details

I. General information

NPI: 1982648721
Provider Name (Legal Business Name): DONALD A DURECKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 PROVIDENT DR
WARSAW IN
46580-3265
US

IV. Provider business mailing address

2518 E DUPONT RD
FORT WAYNE IN
46825-1675
US

V. Phone/Fax

Practice location:
  • Phone: 574-269-4026
  • Fax: 574-269-7444
Mailing address:
  • Phone: 260-432-4400
  • Fax: 260-969-6898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberIN01053282A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: