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General NPI Number Information
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NPI Number | 1154564110
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Entity Type | Organization
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Legal Business Name | HEALTHPARTNERS MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 04/07/2009
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Last Update Date | 08/21/2009
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Provider Practice Location Address
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Address Line | 2307 LAPORTE AVE SUITE 8
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City | VALPARAISO
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State | IN
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Zip | 46383-6997
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Country | US
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Telephone | 219-476-8855
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Fax | 219-476-8840
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Provider Business Mailing Address
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Address Line | 35294 EAGLE WAY
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City | CHICAGO
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State | IL
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Zip | 60678-1352
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Country | US
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Telephone | 219-879-6531
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Fax | 219-872-7869
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT
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Name | BRIAN DONNELLY
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Credential |
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Telephone | 219-873-2905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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