| NPI | 1346597655 |
|---|---|
| Doing Business As | N/A |
| Entity Type | Organization |
| Authorized Contact | DONNA PHALEN Director 219-554-4548 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207N00000X Dermatology |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery | |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
| 207RI0200X Internal Medicine, Infectious Disease | |
| 207RP1001X Internal Medicine, Pulmonary Disease | |
| 207RR0500X Internal Medicine, Rheumatology | |
| 207V00000X Obstetrics & Gynecology | |
| 207X00000X Orthopaedic Surgery | |
| 208000000X Pediatrics | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery | |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 333600000X Pharmacy | |
| 3336C0003X Pharmacy, Community/Retail Pharmacy | |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2021-09-21 |