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General NPI Number Information
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NPI Number | 1356432538
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICINE OF SOUTH BEND PC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 07/09/2008
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Provider Practice Location Address
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Address Line | 610 N MICHIGAN STREET SUITE 308
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City | SOUTH BEND
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State | IN
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Zip | 46601
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Country | US
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Telephone | 574-239-4602
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Fax | 574-239-4607
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Provider Business Mailing Address
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Address Line | 610 N MICHIGAN STREET SUITE 308
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City | SOUTH BEND
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State | IN
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Zip | 46601
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Country | US
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Telephone | 574-239-4602
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Fax | 574-251-2095
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANA S CARDENAS
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Credential | MD
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Telephone | 574-239-4602
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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 | IN
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