Healthcare Provider Details

I. General information

NPI: 1669419776
Provider Name (Legal Business Name): HARRY A MOFFITT DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 04/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7905 CALUMET AVE
MUNSTER IN
46321-2549
US

IV. Provider business mailing address

757 45TH AVE STE. 201
MUNSTER IN
46321-2911
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-5800
  • Fax:
Mailing address:
  • Phone: 219-934-2461
  • Fax: 219-934-2478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number02000940
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: