Provider Demographics
NPI:1174500474
Name:TERPSTRA, WILLIAM G (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:G
Last Name:TERPSTRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:605 E 7TH ST
Mailing Address - Street 2:PO BOX 38
Mailing Address - City:BURLINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46915-9441
Mailing Address - Country:US
Mailing Address - Phone:765-566-3351
Mailing Address - Fax:765-566-2250
Practice Address - Street 1:821 N DIXON RD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-1754
Practice Address - Country:US
Practice Address - Phone:765-452-0878
Practice Address - Fax:765-452-1826
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2011-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01025462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN177280QQOtherMEDICARE
INP00470036OtherRR MCR
IN000000555849BCOtherANTHEM BCBS
IN100060020Medicaid
IN100060020Medicaid