Healthcare Provider Details

I. General information

NPI: 1710244686
Provider Name (Legal Business Name): FAMILY HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6111 HARRISON ST STE 380
MERRILLVILLE IN
46410-2972
US

IV. Provider business mailing address

6111 HARRISON ST STE 380
MERRILLVILLE IN
46410-2972
US

V. Phone/Fax

Practice location:
  • Phone: 219-942-4222
  • Fax: 219-942-4233
Mailing address:
  • Phone: 219-942-4222
  • Fax: 219-942-4233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number200402440
License Number StateIN

VIII. Authorized Official

Name: MS. MUTENA B. KORMAN
Title or Position: OWNER
Credential: MD
Phone: 219-942-4222