Healthcare Provider Details

I. General information

NPI: 1679616924
Provider Name (Legal Business Name): PERKIN KNOT STANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 06/07/2024
Certification Date: 06/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 E 86TH AVE SUITE B
MERRILLVILLE IN
46410-6267
US

IV. Provider business mailing address

99 E 86TH AVE SUITE B
MERRILLVILLE IN
46410-6267
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-3220
  • Fax: 219-736-7164
Mailing address:
  • Phone: 219-738-3220
  • Fax: 219-736-7164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01056783A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01056783A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: