| NPI | 1790189850 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CORI JOHNSON Division Manager 219-795-3360 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10001727A) |
| Enumeration Date | 2014-10-20 |
| Last Update Date | 2014-10-20 |