Healthcare Provider Details
I. General information
NPI: 1013249697
Provider Name (Legal Business Name): MEDICAL SPECIALISTS INC., PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/05/2010
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5529 HOHMAN AVE
HAMMOND IN
46320-1936
US
IV. Provider business mailing address
757-45TH STREET STE 201
MUNSTER IN
46321
US
V. Phone/Fax
- Phone: 219-853-7100
- Fax: 219-937-5958
- Phone: 219-934-2461
- Fax: 219-934-2478
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207R00000X |
| Taxonomy | Internal Medicine Physician |
| License Number | |
| License Number State | IN |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RI0200X |
| Taxonomy | Infectious Disease Physician |
| License Number | |
| License Number State | IN |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RP1001X |
| Taxonomy | Pulmonary Disease Physician |
| License Number | |
| License Number State | IN |
VIII. Authorized Official
Name:
ALEXANDER
A
STEMER
Title or Position: PRESIDENT & CEO
Credential: MD
Phone: 219-934-2461