Provider Demographics
NPI:1639132418
Name:HOUGENDOBLER, DUANE A (MD)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:A
Last Name:HOUGENDOBLER
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 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2003 STULTS ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1291
Practice Address - Country:US
Practice Address - Phone:260-355-3250
Practice Address - Fax:260-355-3259
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031511A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000543343OtherANTHEM
IN000000083942OtherBLUE CROSS BLUE SHIELD
IN100365590Medicaid
IN100365590AMedicaid
IN100365590AMedicaid
IN100365590Medicaid
IND95498Medicare UPIN
IN070860XXMedicare PIN