Healthcare Provider Details

I. General information

NPI: 1013497106
Provider Name (Legal Business Name): 24 ON PHYSICIAN PARTNERS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2018
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 S LAKE PARK AVE
HOBART IN
46342-6638
US

IV. Provider business mailing address

PO BOX 23996
BELFAST ME
04915-4490
US

V. Phone/Fax

Practice location:
  • Phone: 219-945-4580
  • Fax: 219-945-4581
Mailing address:
  • Phone: 770-274-0468
  • Fax: 404-806-4334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DAN A. FULLER
Title or Position: SECRETARY
Credential:
Phone: 770-740-0895