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General NPI Number Information
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NPI Number | 1770582264
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Entity Type | Organization
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Legal Business Name | ILLIANA SURGERY & MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2001 US HIGHWAY 41
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City | SCHERERVILLE
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State | IN
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Zip | 46375-2892
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Country | US
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Telephone | 219-865-7986
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Fax | 219-865-7992
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Provider Business Mailing Address
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Address Line | 701 SUPERIOR AVE ATTN: MANAGED CARE
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City | MUNSTER
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State | IN
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Zip | 46321-4037
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Country | US
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Telephone | 219-641-3051
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Fax | 219-641-4186
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Authorized Official
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Title or Position | CEO
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Name | VIJAY GUPTA
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Credential | MD
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Telephone | 219-922-4200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State | IN
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