Healthcare Provider Details

I. General information

NPI: 1588053292
Provider Name (Legal Business Name): FAMILY ENT & SINUS CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8840 CALUMET AVE SUITE NUMBER 103
MUNSTER IN
46321-2545
US

IV. Provider business mailing address

8840 CALUMET AVE SUITE NUMBER 103
MUNSTER IN
46321-2545
US

V. Phone/Fax

Practice location:
  • Phone: 219-616-3342
  • Fax: 219-836-7245
Mailing address:
  • Phone: 219-616-3342
  • Fax: 219-836-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01074176A
License Number StateIN

VIII. Authorized Official

Name: DR. KEDAR A KAKODKAR
Title or Position: OWNER
Credential: M.D.
Phone: 219-616-3342