Provider Demographics
NPI:1972677599
Name:STERNE, DAVID (DT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:STERNE
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 SOUTHEASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-3948
Mailing Address - Country:US
Mailing Address - Phone:316-698-7723
Mailing Address - Fax:
Practice Address - Street 1:1212 SOUTHEASTERN AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3948
Practice Address - Country:US
Practice Address - Phone:316-698-7723
Practice Address - Fax:317-826-1938
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200622730Medicaid