Healthcare Provider Details

I. General information

NPI: 1912036161
Provider Name (Legal Business Name): PHYSICIANS FOR WOMEN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 03/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 EASTPORT CENTRE DR SUITE 200
VALPARAISO IN
46383-2909
US

IV. Provider business mailing address

880 EASTPORT CENTRE DR SUITE 200
VALPARAISO IN
46383-2909
US

V. Phone/Fax

Practice location:
  • Phone: 219-464-0409
  • Fax: 219-464-2376
Mailing address:
  • Phone: 219-464-0409
  • Fax: 219-464-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number50004100A
License Number StateIN

VIII. Authorized Official

Name: DR. CHRISTOPHER M WIRSING
Title or Position: PRESIDENT
Credential: DO
Phone: 219-464-0409