Healthcare Provider Details

I. General information

NPI: 1710929500
Provider Name (Legal Business Name): JAMES ALAN MCPENCOW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 BROADWAY
MERRILLVILLE IN
46410-7040
US

IV. Provider business mailing address

936 MARY ELLEN DR
CROWN POINT IN
46307-8998
US

V. Phone/Fax

Practice location:
  • Phone: 219-576-6260
  • Fax:
Mailing address:
  • Phone: 219-742-4756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01061558A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01061558A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: