Healthcare Provider Details

I. General information

NPI: 1982653044
Provider Name (Legal Business Name): MUNSTER MEDICAL RESEARCH FOUNDATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/11/2024
Certification Date: 07/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MACARTHUR BLVD ANESTHESIA DEPARTMENT
MUNSTER IN
46321
US

IV. Provider business mailing address

901 MACARTHUR BLVD ANESTHESIA DEPARTMENT
MUNSTER IN
46321-2901
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-7040
  • Fax: 219-513-1127
Mailing address:
  • Phone: 219-836-7040
  • Fax: 219-513-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. CHAR KULLERSTRAND
Title or Position: REGIONAL DIRECTOR PATIENT FINANCIAL
Credential:
Phone: 219-934-8994