Healthcare Provider Details

I. General information

NPI: 1871070847
Provider Name (Legal Business Name): MHG PHYSICIAN SERVICES - INDIANA, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2018
Last Update Date: 07/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

IV. Provider business mailing address

133 BROOKLINE AVE
BOSTON MA
02215-3904
US

V. Phone/Fax

Practice location:
  • Phone: 617-585-9630
  • Fax: 617-585-9625
Mailing address:
  • Phone: 617-585-9630
  • Fax: 617-585-9625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH MICHAEL KESSLER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 617-585-9627