Healthcare Provider Details

I. General information

NPI: 1417031907
Provider Name (Legal Business Name): DEL PILAR MEDICAL & URGENT CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 E DAY RD STE 280
MISHAWAKA IN
46545-3452
US

IV. Provider business mailing address

270 E DAY RD STE 280
MISHAWAKA IN
46545-3452
US

V. Phone/Fax

Practice location:
  • Phone: 574-271-0268
  • Fax: 574-271-0395
Mailing address:
  • Phone: 574-271-0268
  • Fax: 574-271-0395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02001173
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number02001173
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number02001173A
License Number StateIN

VIII. Authorized Official

Name: CANDACE SLUSSER
Title or Position: CEO
Credential:
Phone: 574-271-0268