Healthcare Provider Details

I. General information

NPI: 1902924004
Provider Name (Legal Business Name): LAKE COUNTY CARDIOLOGY AND INTERNAL MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 FRAN LIN PKWY
MUNSTER IN
46321-3540
US

IV. Provider business mailing address

911 FRAN LIN PKWY
MUNSTER IN
46321-3540
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-1980
  • Fax: 219-836-2133
Mailing address:
  • Phone: 219-836-1980
  • Fax: 219-836-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ESTER M CASTOR
Title or Position: OFFICE MANAGER
Credential: RN
Phone: 219-836-1980