Healthcare Provider Details

I. General information

NPI: 1326114463
Provider Name (Legal Business Name): PORTER COUNTY PULMONARY AND CRITICAL CARE MEDICINE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 GLENDALE BLVD SUITE 102
VALPARAISO IN
46383-3767
US

IV. Provider business mailing address

1101 GLENDALE BLVD SUITE 102
VALPARAISO IN
46383-3767
US

V. Phone/Fax

Practice location:
  • Phone: 219-464-9054
  • Fax: 219-465-1749
Mailing address:
  • Phone: 219-464-9054
  • Fax: 219-465-1749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number01038566
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01038566
License Number StateIN

VIII. Authorized Official

Name: DR. DOUGLAS ADOLPH MAZUREK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 219-464-9054