Provider Demographics
NPI:1033153507
Name:THORNBERRY, DENISE K (MD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:K
Last Name:THORNBERRY
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:PO BOX 608
Mailing Address - Street 2:
Mailing Address - City:RUSHVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46173-0608
Mailing Address - Country:US
Mailing Address - Phone:765-932-7591
Mailing Address - Fax:765-932-7505
Practice Address - Street 1:110 E 13TH ST
Practice Address - Street 2:
Practice Address - City:RUSHVILLE
Practice Address - State:IN
Practice Address - Zip Code:46173-2126
Practice Address - Country:US
Practice Address - Phone:765-932-7591
Practice Address - Fax:765-932-7505
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027885207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100346440Medicaid
IN000000635551OtherANTHEM BCBS
IN000000635551OtherANTHEM BCBS
IN941000H1Medicare PIN