Provider Demographics
NPI:1013002237
Name:TRIERWEILER, TERESA (MD)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:TRIERWEILER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4850 CENTURY PLAZA RD
Mailing Address - Street 2:SUITE 180
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5476
Mailing Address - Country:US
Mailing Address - Phone:317-293-4113
Mailing Address - Fax:317-290-2542
Practice Address - Street 1:4880 CENTURY PLAZA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5469
Practice Address - Country:US
Practice Address - Phone:317-293-4113
Practice Address - Fax:317-290-2542
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029333207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100071180Medicaid
IN152520HMedicare PIN
080159298Medicare PIN
INB28390Medicare UPIN
IN151560F9Medicare PIN