| 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 |