Healthcare Provider Details

I. General information

NPI: 1396763330
Provider Name (Legal Business Name): CONSULTANTS IN GASTROENTEROLOGY, SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SUPERIOR AVE SUITE G
MUNSTER IN
46321-4037
US

IV. Provider business mailing address

701 SUPERIOR AVENUE SUITE G
MUNSTER IN
46321
US

V. Phone/Fax

Practice location:
  • Phone: 219-922-3041
  • Fax: 219-922-3048
Mailing address:
  • Phone: 219-922-3041
  • Fax: 219-922-3048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number02000882
License Number StateIN

VIII. Authorized Official

Name: MARK E EFRUSY
Title or Position: PRESIDENT
Credential: DO
Phone: 219-922-3040