Healthcare Provider Details

I. General information

NPI: 1316271760
Provider Name (Legal Business Name): JAMES M PLATIS JR MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 10/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 E 86TH PL
MERRILLVILLE IN
46410-6258
US

IV. Provider business mailing address

210 E 86TH PL
MERRILLVILLE IN
46410-6258
US

V. Phone/Fax

Practice location:
  • Phone: 219-795-1255
  • Fax: 219-738-1953
Mailing address:
  • Phone: 219-795-1255
  • Fax: 219-738-1953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number01043292
License Number StateIN

VIII. Authorized Official

Name: JAMES M PLATIS JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 219-795-1255