Healthcare Provider Details

I. General information

NPI: 1447404546
Provider Name (Legal Business Name): LINCOLN PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 LINCOLNWAY
LA PORTE IN
46350-3350
US

IV. Provider business mailing address

PO BOX 785
LA PORTE IN
46352-0785
US

V. Phone/Fax

Practice location:
  • Phone: 219-326-5400
  • Fax: 219-326-5455
Mailing address:
  • Phone: 219-326-5400
  • Fax: 219-326-5455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01049378A
License Number StateIN

VIII. Authorized Official

Name: DR. ADAM SERGIWA
Title or Position: CEO
Credential: MD
Phone: 219-326-5400