Healthcare Provider Details

I. General information

NPI: 1851657779
Provider Name (Legal Business Name): CHILDRENS AND FAMILY HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 04/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E 86TH CT
MERRILLVILLE IN
46410-6259
US

IV. Provider business mailing address

205 E 86TH CT
MERRILLVILLE IN
46410-6259
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-9070
  • Fax: 219-769-1758
Mailing address:
  • Phone: 219-769-9070
  • Fax: 219-769-1758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003925B
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003925A
License Number StateIN

VIII. Authorized Official

Name: DR. AZRA SHIBLI SHERIFF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 219-769-9070