Healthcare Provider Details

I. General information

NPI: 1689758583
Provider Name (Legal Business Name): HIGH RISK OBSTETRICS & DIAGNOSTICS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 09/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 S MAIN ST SUITE 203
CROWN POINT IN
46307-3676
US

IV. Provider business mailing address

1205 S MAIN ST SUITE 203
CROWN POINT IN
46307-3676
US

V. Phone/Fax

Practice location:
  • Phone: 219-213-2280
  • Fax: 219-213-2280
Mailing address:
  • Phone: 219-213-2280
  • Fax: 219-213-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS ALLAN LOSURE
Title or Position: PRESIDENT HIGH RISK OB
Credential: DO
Phone: 219-213-2280