| NPI | 1073500930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REBECCA MAKSIMOVICH Clinical Coordinator 219-942-9600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA1903X Clinic/Center, Ambulatory Surgical (Licence: IN 261QA1903X) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2020-08-22 |