Healthcare Provider Details

I. General information

NPI: 1528623824
Provider Name (Legal Business Name): 219 HEALTH NETWORK INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2019
Last Update Date: 05/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3432 169TH ST
HAMMOND IN
46323-2542
US

IV. Provider business mailing address

100 W CHICAGO AVE STE F
EAST CHICAGO IN
46312-3261
US

V. Phone/Fax

Practice location:
  • Phone: 219-844-9060
  • Fax: 219-844-6912
Mailing address:
  • Phone: 219-703-2583
  • Fax: 219-703-6749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. IBRAHIM MOHAMMED NAJAMUDDIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 219-703-2585