Healthcare Provider Details

I. General information

NPI: 1609175777
Provider Name (Legal Business Name): DAVID WILLIAM PARKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E DOUGLAS RD SUITE 408
MISHAWAKA IN
46545-1464
US

IV. Provider business mailing address

707 E CEDAR ST STE 405
SOUTH BEND IN
46617-2059
US

V. Phone/Fax

Practice location:
  • Phone: 574-335-6440
  • Fax: 574-333-5060
Mailing address:
  • Phone: 574-335-8707
  • Fax: 574-335-0750

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number26704
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01072634A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: