| NPI | 1730956194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE SPENCER BANDY CEO 219-331-8330 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 261Q00000X Clinic/Center |
| Enumeration Date | 2023-12-06 |
| Last Update Date | 2024-09-27 |