| NPI | 1508954322 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES DYKE EGNATZ Owner President 219-865-2691 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01019054A) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-08-22 |