| NPI | 1093188229 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA PHALEN Director 219-554-4548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist |
| Additional Taxonomies | 208000000X Pediatrics |
| 208600000X Surgery | |
| 207Q00000X Family Medicine | |
| 207RR0500X Internal Medicine, Rheumatology | |
| 207RI0200X Internal Medicine, Infectious Disease | |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2026-01-23 |