| NPI | 1285298067 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KANAYO ODELUGA Md/Owner 219-397-6000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Enumeration Date | 2019-04-26 |
| Last Update Date | 2020-01-09 |