| NPI | 1134585029 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MITCHELL LESLIE BRESSACK Owner 219-662-8856 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: IN 01031629A) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IN 02004576A) |
| 207ND0900X Dermatology, Dermatopathology (Licence: IN 01043884A) | |
| 363AM0700X Physician Assistant, Medical (Licence: IN 10000889A) | |
| Enumeration Date | 2016-01-07 |
| Last Update Date | 2016-01-07 |