| NPI | 1225327984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DONNA PHALEN Director 219-554-4548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2023-02-27 |