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General NPI Number Information
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NPI Number | 1073660049
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Entity Type | Organization
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Legal Business Name | WILLOW CREEK MEDICAL LLC
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 12/17/2010
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Provider Practice Location Address
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Address Line | 3156 WILLOWCREEK RD
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City | PORTAGE
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State | IN
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Zip | 46368-4424
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Country | US
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Telephone | 219-762-4999
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Fax | 219-762-2288
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Provider Business Mailing Address
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Address Line | 3156 WILLOWCREEK RD
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City | PORTAGE
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State | IN
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Zip | 46368-4424
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Country | US
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Telephone | 219-762-4999
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Fax | 219-762-2288
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ASHWANI KUMAR
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Credential | M.D.
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Telephone | 219-762-4999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 010133934B
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License Number State | IN
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