Healthcare Provider Details

I. General information

NPI: 1497838593
Provider Name (Legal Business Name): WILLIAM JOHN PIERCE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 90TH DRIVE
MERRILLVILLE IN
46410-8102
US

IV. Provider business mailing address

210 E 90TH DRIVE
MERRILLVILLE IN
46410-8102
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-2008
  • Fax: 219-738-2127
Mailing address:
  • Phone: 219-738-2008
  • Fax: 219-738-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01025010
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: