| NPI | 1417031907 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CANDACE SLUSSER CEO 574-271-0268 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: IN 02001173A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 02001173) |
| 208000000X Pediatrics (Licence: IN 02001173) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2022-03-28 |