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General NPI Number Information
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NPI Number | 1154801694
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Entity Type | Organization
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Legal Business Name | ADVANCED ORTHOPEDICS AND SPORTS MEDICINE LLC
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 11/27/2018
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Provider Practice Location Address
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Address Line | 1129 MERRILLVILLE RD
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City | CROWN POINT
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State | IN
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Zip | 46307-2710
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Country | US
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Telephone | 219-213-6630
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Fax | 337-210-7775
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Provider Business Mailing Address
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Address Line | 1129 MERRILLVILLE RD
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City | CROWN POINT
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State | IN
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Zip | 46307-2710
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Country | US
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Telephone | 219-213-6630
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Fax | 219-750-1256
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. JENNIFER LYNN BAYER
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Credential | MD
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Telephone | 219-213-6630
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 01072457A
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License Number State | IN
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