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NPI Code Detail

MEDICARE: 219 HEALTH NETWORK INC

MEDICARE: 219 HEALTH NETWORK INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1538724075
Entity Type Code : Organization
Provider Name (Legal Business Name) : 219 HEALTH NETWORK INC
Provider Business Mailing Address
First Line : 100 W CHICAGO AVE STE F
Second Line :
City : EAST CHICAGO
State : IN
Zip : 46312-3261
Country : US
Telephone Number : 219-703-2583
Fax Number : 219-702-6749
Provider Business Practice Location Address
First Line : 2020 E COLUMBUS DR STE A
Second Line :
City : EAST CHICAGO
State : IN
Zip : 46312-2830
Country : US
Telephone Number : 219-703-2583
Fax Number : 219-703-6749
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : IBRAHIM MOHAMMED NAJAMUDDIN
Credential :
Telephone Number : 219-703-2585
Provider Enumeration Date : 05/09/2019
Last Update Date : 05/09/2019

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Directions to “219 HEALTH NETWORK INC ” Practice Location

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