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General NPI Number Information
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NPI Number | 1124202262
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Entity Type | Organization
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Legal Business Name | RENAISSANCE WOMENS CENTER, LLC
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Dates
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Enumeration Date | 12/26/2007
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 6111 HARRISON ST SUITE 255
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City | MERRILLVILLE
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State | IN
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Zip | 46410-2969
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Country | US
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Telephone | 773-887-7313
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Fax |
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Provider Business Mailing Address
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Address Line | 6111 HARRISON ST SUITE 255
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City | MERRILLVILLE
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State | IN
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Zip | 46410-2969
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Country | US
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Telephone | 773-887-7313
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | DR. DEBORAH LYNNE MCCULLOUGH
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Credential | MD
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Telephone | 219-887-7313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01026315A
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License Number State | IN
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