Healthcare Provider Details

I. General information

NPI: 1760601389
Provider Name (Legal Business Name): PULMONARY SPECIALISTS OF NORTHWEST INDIANA, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 09/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7875 GRAND BLVD
HOBART IN
46342-6665
US

IV. Provider business mailing address

7875 GRAND BLVD
HOBART IN
46342-6665
US

V. Phone/Fax

Practice location:
  • Phone: 219-942-9658
  • Fax: 219-947-1996
Mailing address:
  • Phone: 219-942-9658
  • Fax: 219-947-1996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATHY FRANK
Title or Position: OFFICE MANAGER
Credential:
Phone: 219-942-9658