| NPI | 1013029883 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH WALTER BLUMENTHAL President 219-762-3175 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 50004219A) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-08-07 |