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General NPI Number Information
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NPI Number | 1689758583
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Entity Type | Organization
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Legal Business Name | HIGH RISK OBSTETRICS & DIAGNOSTICS SC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 09/22/2016
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Provider Practice Location Address
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Address Line | 1205 S MAIN ST SUITE 203
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City | CROWN POINT
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State | IN
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Zip | 46307-3676
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Country | US
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Telephone | 219-213-2280
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Fax | 219-213-2280
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Provider Business Mailing Address
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Address Line | 1205 S MAIN ST SUITE 203
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City | CROWN POINT
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State | IN
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Zip | 46307-3676
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Country | US
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Telephone | 219-213-2280
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Fax | 219-213-2280
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Authorized Official
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Title or Position | PRESIDENT HIGH RISK OB
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Name | DR. THOMAS ALLAN LOSURE
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Credential | DO
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Telephone | 219-213-2280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number |
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License Number State |
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