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General NPI Number Information
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NPI Number | 1336271253
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Entity Type | Organization
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Legal Business Name | MISHAWAKA OSTEOPATHIC CLINIC
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Dates
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Enumeration Date | 03/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1207 LINCOLN WAY WEST
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City | MISHAWAKA
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State | IN
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Zip | 46544
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Country | US
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Telephone | 574-255-4733
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Fax | 574-255-4464
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Provider Business Mailing Address
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Address Line | 1207 LINCOLN WAY WEST
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City | MISHAWAKA
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State | IN
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Zip | 46544
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Country | US
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Telephone | 574-255-4733
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Fax | 574-255-4464
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAX E HELMAN
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Credential | DO
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Telephone | 574-255-4733
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02000433
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License Number State | IN
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