Healthcare Provider Details

I. General information

NPI: 1316011976
Provider Name (Legal Business Name): CURTIS FAMILY PRACTICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 N. CURTIS DRIVE SUITE B
WINAMAC IN
46996-8818
US

IV. Provider business mailing address

2418 N. CURTIS DRIVE SUITE B
WINAMAC IN
46996-8818
US

V. Phone/Fax

Practice location:
  • Phone: 574-946-7900
  • Fax: 574-946-7936
Mailing address:
  • Phone: 574-946-7900
  • Fax: 574-946-7936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02000870B
License Number StateIN

VIII. Authorized Official

Name: ELIZABETH A CURTIS
Title or Position: PHYSICIANOWNER
Credential: D.O.
Phone: 574-946-7900