Healthcare Provider Details

I. General information

NPI: 1164830196
Provider Name (Legal Business Name): DOBBEN MEDICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 FRANKLIN ST
MICHIGAN CITY IN
46360-7310
US

IV. Provider business mailing address

55 E 86TH AVE ATTN DENISE Z
MERRILLVILLE IN
46410-6382
US

V. Phone/Fax

Practice location:
  • Phone: 219-874-3313
  • Fax: 219-878-2330
Mailing address:
  • Phone: 219-769-1670
  • Fax: 219-738-6714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD DOBBEN
Title or Position: OWNER
Credential: MD
Phone: 219-861-0417