| NPI | 1265654099 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CONSTANCIO B ACOSTA Physician Pediatrician 219-736-9580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IN 01025495) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-08-22 |