Healthcare Provider Details

I. General information

NPI: 1568437937
Provider Name (Legal Business Name): JOSEPH PHILLIP SPOTT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 01/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 FIR ST SUITE 417
EAST CHICAGO IN
46312-3052
US

IV. Provider business mailing address

9430 WICKER AVE
SAINT JOHN IN
46373-9768
US

V. Phone/Fax

Practice location:
  • Phone: 219-397-8648
  • Fax: 219-397-8653
Mailing address:
  • Phone: 219-558-8068
  • Fax: 219-558-8149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number02001917A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: