Healthcare Provider Details

I. General information

NPI: 1922890102
Provider Name (Legal Business Name): MICHAEL BURTON PONSTEIN RPHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 RICHARD GORDON HATCHER BLVD
GARY IN
46404-3508
US

IV. Provider business mailing address

2500 RICHARD GORDON HATCHER BLVD
GARY IN
46404-3508
US

V. Phone/Fax

Practice location:
  • Phone: 219-949-1055
  • Fax: 219-944-7371
Mailing address:
  • Phone: 219-949-1055
  • Fax: 219-944-7371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number67034854A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: