Healthcare Provider Details

I. General information

NPI: 1871586701
Provider Name (Legal Business Name): CHARLES J REBESCO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 08/05/2010
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 Number01031652
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: