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General NPI Number Information
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NPI Number | 1740406602
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Entity Type | Organization
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Legal Business Name | INSTITUTE OF FAMILY HEALTH
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 5454 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410
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Country | US
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Telephone | 219-884-2600
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Fax | 219-985-0570
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Provider Business Mailing Address
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Address Line | 5454 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-1648
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Country | US
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Telephone | 219-884-2600
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Fax | 219-985-0570
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Authorized Official
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Title or Position | SURGEON
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Name | DR. JERALD S
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Credential | M.D.
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Telephone | 708-798-4664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146D00000X
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Taxonomy Name | Personal Emergency Response Attendant
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License Number | 01026604A
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License Number State | IN
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