Provider Demographics
NPI:1861557944
Name:DUERFELDT, TODD WILLIAM (DO)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:WILLIAM
Last Name:DUERFELDT
Suffix:
Gender:M
Credentials:DO
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 RD STE 100
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-1291
Practice Address - Country:US
Practice Address - Phone:260-356-5424
Practice Address - Fax:260-358-2090
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002837A207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000961666OtherANTHEM
IN200983060Medicaid
IN296260032Medicare PIN
IN200983060Medicaid
IN000000652092OtherANTHEM
IL036-108718Medicaid
ILG91468Medicare UPIN
IL8032023OtherANTHEM
ILIL1242001Medicare PIN