NPI | 1780117200 |
---|---|
Doing Business As | DEKALB HEALTH MEDICAL GROUP |
Entity Type | Organization |
Authorized Contact | CRAIG POLKOW CEO 260-920-2501 |
Organization Subpart ? | No |
Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
Additional Taxonomies | 207Q00000X Family Medicine |
Enumeration Date | 2017-04-11 |
Last Update Date | 2017-04-11 |