Provider Demographics
NPI:1265462410
Name:FIGUEROA, EDDUYN A (MD)
Entity Type:Individual
Prefix:
First Name:EDDUYN
Middle Name:A
Last Name:FIGUEROA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 PARK PLACE CIR STE 150
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3580
Mailing Address - Country:US
Mailing Address - Phone:574-273-2440
Mailing Address - Fax:
Practice Address - Street 1:425 PARK PLACE CIR STE 150
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3580
Practice Address - Country:US
Practice Address - Phone:574-273-2440
Practice Address - Fax:574-273-2477
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045208A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200103430BMedicaid
INA09770Medicare UPIN
IN200103430BMedicaid