Provider Demographics
NPI:1972793800
Name:DURFEE, KIERSA DIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:KIERSA
Middle Name:DIANE
Last Name:DURFEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3403 E RAYMOND ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-4744
Mailing Address - Country:US
Mailing Address - Phone:317-957-2000
Mailing Address - Fax:317-957-2050
Practice Address - Street 1:2855 N KEYSTONE AVE
Practice Address - Street 2:#100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-2789
Practice Address - Country:US
Practice Address - Phone:317-957-2300
Practice Address - Fax:317-957-2320
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01072818A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000114200Medicaid
FL48292OtherBLUE CROSS/BLUE SHIELD
FL000114200Medicaid