Healthcare Provider Details

I. General information

NPI: 1245642958
Provider Name (Legal Business Name): KASSANDRA RENEE POPLAWSKI HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KASSANDRA RENEE WOODCOX HIS

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 05/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E 90TH DR
MERRILLVILLE IN
46410
US

IV. Provider business mailing address

112 E 90TH DR
MERRILLVILLE IN
46410
US

V. Phone/Fax

Practice location:
  • Phone: 219-525-4485
  • Fax: 219-473-0633
Mailing address:
  • Phone: 219-525-4485
  • Fax: 219-473-0633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number17001344A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: