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General NPI Number Information
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NPI Number | 1760593776
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Entity Type | Organization
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Legal Business Name | INDIANA UNIVERSITY HEALTH LA PORTE PHYSICIANS INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 1007 LINCOLNWAY
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City | LA PORTE
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State | IN
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Zip | 46350-3201
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Country | US
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Telephone | 219-326-2489
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Fax | 219-326-2584
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Provider Business Mailing Address
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Address Line | PO BOX 1690
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City | LA PORTE
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State | IN
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Zip | 46352-1690
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Country | US
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Telephone | 219-326-2312
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Fax | 219-326-2584
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Authorized Official
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Title or Position | VP OF STRATEGY & AMBULATORY SERVICE
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Name | BRIAN DONNELLY
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Credential |
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Telephone | 219-325-4682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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