Healthcare Provider Details

I. General information

NPI: 1912952060
Provider Name (Legal Business Name): ANESTHESIA ASSOCIATES OF NORTHWEST INDIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 10/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

541 OTIS BOWEN DR
MUNSTER IN
46321-4158
US

IV. Provider business mailing address

1500 SOUTH LAKE PARK AVE
HOBART IN
46342
US

V. Phone/Fax

Practice location:
  • Phone: 219-934-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JORGE GONZALEZ
Title or Position: MANAGER
Credential: M.D.
Phone: 219-934-5300