| NPI | 1639577794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON M PETRUNGARO President 219-836-1163 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: IN 01074460A) |
| Enumeration Date | 2014-12-05 |
| Last Update Date | 2015-05-08 |