Provider Demographics
NPI:1376602482
Name:TRUCHAN, JONATHAN JAMES (DPM)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAMES
Last Name:TRUCHAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 CLINE AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-2204
Mailing Address - Country:US
Mailing Address - Phone:219-736-8915
Mailing Address - Fax:219-736-8928
Practice Address - Street 1:303 W 89TH AVE
Practice Address - Street 2:STE E1
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6295
Practice Address - Country:US
Practice Address - Phone:219-736-8915
Practice Address - Fax:219-736-8928
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2019-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000937A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000527538OtherANTHEM
000000250470OtherANTHEM
0007539414OtherAETNA
IN200499240Medicaid
000000250471OtherANTHEM
IN144340LMedicare PIN
0007539414OtherAETNA
IN000000527538OtherANTHEM
000000250470OtherANTHEM
U90959Medicare UPIN