Healthcare Provider Details

I. General information

NPI: 1336271253
Provider Name (Legal Business Name): MISHAWAKA OSTEOPATHIC CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 LINCOLN WAY WEST
MISHAWAKA IN
46544
US

IV. Provider business mailing address

1207 LINCOLN WAY WEST
MISHAWAKA IN
46544
US

V. Phone/Fax

Practice location:
  • Phone: 574-255-4733
  • Fax: 574-255-4464
Mailing address:
  • Phone: 574-255-4733
  • Fax: 574-255-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02000433
License Number StateIN

VIII. Authorized Official

Name: DR. MAX E HELMAN
Title or Position: OWNER
Credential: DO
Phone: 574-255-4733