Healthcare Provider Details

I. General information

NPI: 1013198092
Provider Name (Legal Business Name): LA PORTE REGIONAL PHYSICIAN NETWORK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 LINCOLNWAY SUITE 302
LA PORTE IN
46350-3430
US

IV. Provider business mailing address

PO BOX 1690
LA PORTE IN
46352-1690
US

V. Phone/Fax

Practice location:
  • Phone: 219-326-2312
  • Fax: 219-326-2584
Mailing address:
  • Phone: 219-326-2312
  • Fax: 219-326-2584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RHONDA VOLK
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 219-326-2485