Healthcare Provider Details

I. General information

NPI: 1659516334
Provider Name (Legal Business Name): DAVID S. MENDELOWITZ MD SURGERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 STATE ST STE 2C
LA PORTE IN
46350-3134
US

IV. Provider business mailing address

1300 STATE ST STE 2C
LA PORTE IN
46350-3134
US

V. Phone/Fax

Practice location:
  • Phone: 219-325-0152
  • Fax: 219-325-8621
Mailing address:
  • Phone: 219-325-0152
  • Fax: 219-325-8621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number2989
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number01030941A
License Number StateIN

VIII. Authorized Official

Name: DR. DAVID SAMUEL MENDELOWITZ
Title or Position: PRESIDENT
Credential: MD
Phone: 219-325-0152