Healthcare Provider Details

I. General information

NPI: 1811390925
Provider Name (Legal Business Name): EMILY MARIE REDICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY MARIE CAIN

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 11/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S LAKE PARK AVE STE 200
HOBART IN
46342-6790
US

IV. Provider business mailing address

1400 S LAKE PARK AVE STE 200
HOBART IN
46342-6790
US

V. Phone/Fax

Practice location:
  • Phone: 219-947-6122
  • Fax:
Mailing address:
  • Phone: 219-947-6122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: