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General NPI Number Information
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NPI Number | 1861150419
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Entity Type | Organization
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Legal Business Name | CALUMET QUICK CARE LTD
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Dates
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Enumeration Date | 12/01/2021
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Last Update Date | 12/03/2024
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Provider Practice Location Address
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Address Line | 5518 CALUMET AVE
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City | HAMMOND
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State | IN
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Zip | 46320-2017
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Country | US
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Telephone | 219-803-0379
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 786
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City | FLOSSMOOR
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State | IL
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Zip | 60422-0786
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Country | US
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Telephone | 219-803-0379
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Fax | 865-381-0480
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD O WATSON
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Credential | MD
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Telephone | 888-855-2995
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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