Healthcare Provider Details

I. General information

NPI: 1265485635
Provider Name (Legal Business Name): MEDICAL SPECIALISTS INC., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 45TH STREET STE 201 MEDICAL SPECIALISTS
MUNSTER IN
46321
US

IV. Provider business mailing address

757 45TH STREET STE 201MEDICAL SPECIALISTS ATTN C MCGEE
MUNSTER IN
46321
US

V. Phone/Fax

Practice location:
  • Phone: 219-934-2461
  • Fax: 219-934-2478
Mailing address:
  • Phone: 219-934-2461
  • Fax: 219-934-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number50002494A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number50002494A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50002494A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50002494A
License Number StateIN
# 5
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number50002494A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number50002494A
License Number StateIN
# 7
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number50002494A
License Number StateIN
# 8
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number50002494A
License Number StateIN
# 9
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number50002494A
License Number StateIN
# 10
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50002494A
License Number StateIN
# 11
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberXF200828
License Number StateIN
# 12
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number50002494A
License Number StateIN
# 13
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000920A
License Number StateIN
# 14
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number50002494A
License Number StateIN

VIII. Authorized Official

Name: CAREN GEGENHEIMER
Title or Position: CFO
Credential:
Phone: 219-934-2461