Provider Demographics
NPI:1639157308
Name:TERHUNE, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:TERHUNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:6461 DEANS HILL RD
Mailing Address - Street 2:
Mailing Address - City:BERRIEN CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49102-9750
Mailing Address - Country:US
Mailing Address - Phone:269-471-7741
Mailing Address - Fax:269-471-1581
Practice Address - Street 1:815 ST. JOSEPH DRIVE
Practice Address - Street 2:
Practice Address - City:ST. JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-2529
Practice Address - Country:US
Practice Address - Phone:269-983-3455
Practice Address - Fax:269-983-5920
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2012-05-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301063125208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI104171481Medicaid
IN207050CMedicare PIN
MIMI2051095Medicare PIN
D60905Medicare UPIN