| NPI | 1497866198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FAUSTO O MAGNO Co Owner 219-736-1500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01054491A) |
| Additional Taxonomies | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology (Licence: IN 01036035) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2008-04-07 |