Healthcare Provider Details

I. General information

NPI: 1841273232
Provider Name (Legal Business Name): WOMEN'S SPECIALIST OF NORTHWEST INDIANA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3924-26 MAIN ST. SUITE 202
EAST CHICAGO IN
46312
US

IV. Provider business mailing address

3924-26 MAIN ST. SUITE 202
EAST CHICAGO IN
46312
US

V. Phone/Fax

Practice location:
  • Phone: 219-397-2008
  • Fax: 219-398-1339
Mailing address:
  • Phone: 219-397-2008
  • Fax: 219-398-1339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01036148A
License Number StateIN

VIII. Authorized Official

Name: DR. KIMBERLY D. ARTHUR
Title or Position: CEO
Credential: M.D.
Phone: 219-397-2008