| NPI | 1396754073 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHANIEL ROSS Physician/Owner 219-769-1670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01052287) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2020-08-22 |