Healthcare Provider Details

I. General information

NPI: 1124166038
Provider Name (Legal Business Name): THE GOOD DOCTOR, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 11/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

952 S COURT ST
CROWN POINT IN
46307-4848
US

IV. Provider business mailing address

8126 PULASKI ST
SCHERERVILLE IN
46375-2531
US

V. Phone/Fax

Practice location:
  • Phone: 219-226-0650
  • Fax: 219-226-0618
Mailing address:
  • Phone: 219-365-5405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02001581A
License Number StateIN

VIII. Authorized Official

Name: DR. TROY W STOVALL
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 219-365-5405