Healthcare Provider Details

I. General information

NPI: 1154959179
Provider Name (Legal Business Name): MUNSTER SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 45THSTREET UNIT 101
MUNSTER IN
46321
US

IV. Provider business mailing address

1100 JOLIET ST STE 201
DYER IN
46311-1995
US

V. Phone/Fax

Practice location:
  • Phone: 414-455-1153
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VISHAL LAL
Title or Position: CEO
Credential:
Phone: 414-455-1153