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General NPI Number Information
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NPI Number | 1740267822
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Entity Type | Organization
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Legal Business Name | GENERAL & VASCULAR SURGERY PC
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Dates
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Enumeration Date | 12/29/2005
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Last Update Date | 05/07/2008
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Provider Practice Location Address
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Address Line | 621 MEMORIAL DR
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City | SOUTH BEND
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State | IN
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Zip | 46601-1064
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Country | US
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Telephone | 574-236-1888
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Fax | 574-236-1887
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Provider Business Mailing Address
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Address Line | 621 MEMORIAL DR
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City | SOUTH BEND
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State | IN
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Zip | 46601-1064
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Country | US
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Telephone | 574-236-1888
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Fax | 574-236-1887
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Authorized Official
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Title or Position | PRACTICE MANGER
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Name | JOHN MCGINLEY
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Credential |
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Telephone | 574-236-1888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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