Active NPI
Daniel J Triezenberg, MD
- Family Medicine Physician
- Mishawaka, IN
National Provider Identifier
1124100698
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 01050823
- Practice address
- 420 W 4TH St
Mishawaka, IN 46544-1948 - Phone
- (219) 462-7173
- Fax
- (574) 307-7692
- NPI assigned
- Oct 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 01050823 | IN | Primary |
Addresses
Primary practice location
420 W 4TH St
Mishawaka, IN 46544-1948
Mailing address
420 W 4TH St
Mishawaka, IN 46544-1948
Phone (574) 307-7673
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200239800 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01050823 | IN | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161302400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475020800000",
"number": "1124100698",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "420 W 4TH ST",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465441948",
"telephone_number": "574-307-7673",
"fax_number": "574-307-7692"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "420 W 4TH ST",
"city": "MISHAWAKA",
"state": "IN",
"postal_code": "465441948",
"telephone_number": "219-462-7173",
"fax_number": "574-307-7692"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRIEZENBERG",
"first_name": "DANIEL",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-20",
"last_updated": "2016-09-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IN",
"license": "01050823",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200239800",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mishawaka, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.