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General NPI Number Information
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NPI Number | 1386751931
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Entity Type | Individual
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Provider Name | JUAN J CORREA M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/23/2006
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Last Update Date | 08/18/2010
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Provider Practice Location Address
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Address Line | 1711 N 6 1/2 ST STE 200
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City | TERRE HAUTE
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State | IN
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Zip | 47804-2766
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Country | US
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Telephone | 812-242-3610
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Fax | 812-242-3630
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Provider Business Mailing Address
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Address Line | 221 S 6TH ST
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City | TERRE HAUTE
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State | IN
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Zip | 47807-4214
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Country | US
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Telephone | 812-242-3610
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Fax | 812-242-3630
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 01027664A
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License Number State | IN
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