Provider Demographics
NPI:1548205057
Name:UHRHAMMER, DENNIS C (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:C
Last Name:UHRHAMMER
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:RCS PROVIDER ENROLLMENT, ATTN: KAREN MINCH
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:765-282-8991
Mailing Address - Fax:
Practice Address - Street 1:7230 ENGLE RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804
Practice Address - Country:US
Practice Address - Phone:260-234-5400
Practice Address - Fax:260-234-5410
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047143A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000206194OtherBLUE CROSS
IN200102530Medicaid
IN200102530Medicaid
000000206194OtherBLUE CROSS
IN185760BMedicare ID - Type Unspecified