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General NPI Number Information
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NPI Number | 1346958998
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Entity Type | Organization
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Legal Business Name | MICHIANA CONCIERGE FAMILY MEDICINE
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Dates
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Enumeration Date | 11/14/2022
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Last Update Date | 01/27/2023
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Provider Practice Location Address
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Address Line | 1217 W PLYMOUTH ST
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City | BREMEN
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State | IN
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Zip | 46506-1930
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Country | US
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Telephone | 574-546-0654
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Fax | 888-815-1434
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Provider Business Mailing Address
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Address Line | 1217 W PLYMOUTH ST
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City | BREMEN
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State | IN
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Zip | 46506-1930
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Country | US
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Telephone | 574-546-0654
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Fax | 888-815-1434
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Authorized Official
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Title or Position | OWNER
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Name | GRACIELA JIMENEZ-MARTINEZ
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Credential | NURSE PRACTITIONER
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Telephone | 574-546-0654
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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 |
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License Number State |
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