Healthcare Provider Details

I. General information

NPI: 1619356607
Provider Name (Legal Business Name): ENHANCED PRACTICE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5908 COLUMBIA AVE
HAMMOND IN
46320-2610
US

IV. Provider business mailing address

5908 COLUMBIA AVE
HAMMOND IN
46320-2610
US

V. Phone/Fax

Practice location:
  • Phone: 219-803-7380
  • Fax: 219-803-7551
Mailing address:
  • Phone: 219-803-7380
  • Fax: 219-803-7551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number StateIN

VIII. Authorized Official

Name: MR. ROBERT J. NEWELL
Title or Position: MEMBER
Credential:
Phone: 219-677-2269