Healthcare Provider Details

I. General information

NPI: 1255917647
Provider Name (Legal Business Name): INFORME HC SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 GREAT LAKES DR
DYER IN
46311-1917
US

IV. Provider business mailing address

2741 W LAYTON AVE STE 106
MILWAUKEE WI
53221-2600
US

V. Phone/Fax

Practice location:
  • Phone: 219-322-3555
  • Fax: 888-724-0875
Mailing address:
  • Phone: 414-242-5468
  • Fax: 888-724-0875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JODI CZERNEJEWSKI
Title or Position: CEO
Credential:
Phone: 414-242-5468