Healthcare Provider Details

I. General information

NPI: 1679536320
Provider Name (Legal Business Name): ELWOOD FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SO R ST
ELWOOD IN
46036
US

IV. Provider business mailing address

PO BOX 474
ELWOOD IN
46036-0474
US

V. Phone/Fax

Practice location:
  • Phone: 765-552-7316
  • Fax: 765-552-7306
Mailing address:
  • Phone: 765-552-7316
  • Fax: 765-552-7306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50003477A
License Number StateIN

VIII. Authorized Official

Name: DR. ROBERT JAMES HELM
Title or Position: PRESIDENT
Credential: MD
Phone: 765-552-7316