Healthcare Provider Details

I. General information

NPI: 1558654442
Provider Name (Legal Business Name): KOBAK CENTER FOR GYNECOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2011
Last Update Date: 10/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WALL ST SUITE J
VALPARAISO IN
46383-2521
US

IV. Provider business mailing address

401 WALL ST SUITE J
VALPARAISO IN
46383-2521
US

V. Phone/Fax

Practice location:
  • Phone: 219-531-7500
  • Fax:
Mailing address:
  • Phone: 219-531-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number01046101A
License Number StateIN

VIII. Authorized Official

Name: WILLIAM H KOBAK
Title or Position: PRESIDENT
Credential: MD
Phone: 219-531-7500