Healthcare Provider Details

I. General information

NPI: 1164587606
Provider Name (Legal Business Name): DEWNZAR HOWARD MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 12/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SUPERIOR AVE SUITE K
MUNSTER IN
46321-4037
US

IV. Provider business mailing address

55 E 86TH AVE PO BOX 10645
MERRILLVILLE IN
46410-6382
US

V. Phone/Fax

Practice location:
  • Phone: 219-934-4100
  • Fax: 219-934-4102
Mailing address:
  • Phone: 219-769-1670
  • Fax: 219-738-6714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number01039634
License Number StateIN

VIII. Authorized Official

Name: DEWNZAR HOWARD
Title or Position: OWNER-PHYSICIAN
Credential: MD
Phone: 219-934-4100