Provider Demographics
NPI:1811966823
Name:DUNCO, DOUGLAS MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:DUNCO
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:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:2403 LOY DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-2701
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-446-4351
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045408A2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000188800OtherANTHEM PROVIDER NUMBER
IN200075990Medicaid
IN10825030OtherCAQH NUMBER
IN9274774OtherPHCS PID NUMBER
IN815460OOMedicare PIN
IN142080AAAMedicare PIN
IN224390GMedicare PIN
IN10825030OtherCAQH NUMBER
IN000000188800OtherANTHEM PROVIDER NUMBER
ING00286Medicare UPIN
IN185510GGMedicare PIN
IN815510QQMedicare PIN