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General NPI Number Information
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NPI Number | 1407709116
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Entity Type | Organization
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Legal Business Name | MAPLE CITY MEDICAL LLC
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Dates
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Enumeration Date | 02/20/2026
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Last Update Date | 02/20/2026
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Provider Practice Location Address
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Address Line | 1700 LINCOLNWAY PL STE 8
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City | LA PORTE
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State | IN
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Zip | 46350-3194
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Country | US
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Telephone | 219-369-3177
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Fax | 219-325-0855
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Provider Business Mailing Address
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Address Line | 1700 LINCOLNWAY PL STE 8
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City | LA PORTE
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State | IN
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Zip | 46350-3194
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Country | US
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Telephone | 219-369-3177
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Fax | 219-325-0855
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTINE MADDOX
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Credential | FNP
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Telephone | 219-369-3177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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