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General NPI Number Information
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NPI Number | 1689712093
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE CENTER OF NW INDIANA, PC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 04/12/2011
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Provider Practice Location Address
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Address Line | 5800 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-2601
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Country | US
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Telephone | 219-985-1112
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Fax | 219-985-1150
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Provider Business Mailing Address
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Address Line | 5800 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-2601
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Country | US
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Telephone | 219-985-1112
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Fax | 219-985-1150
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. ROBYN DALE POLK
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Credential | CRTT
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Telephone | 219-985-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 227800000X
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Taxonomy Name | Certified Respiratory Therapist
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License Number | 30001586A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 227800000X
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Taxonomy Name | Certified Respiratory Therapist
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License Number | 30001325A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 05007981A
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License Number State | IN
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