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General NPI Number Information
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NPI Number | 1891375275
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Entity Type | Organization
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Legal Business Name | MEDICINE REIMAGINED DPC
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Dates
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Enumeration Date | 04/10/2021
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 1720 W LINCOLN AVE
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City | GOSHEN
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State | IN
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Zip | 46526-5906
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Country | US
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Telephone | 574-319-1420
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Fax |
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Provider Business Mailing Address
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Address Line | 511 N GREENE RD
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City | GOSHEN
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State | IN
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Zip | 46526-1309
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Country | US
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Telephone | 574-319-1420
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. KIMBERLY STUCKEY-SCHROCK
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Credential | MD
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Telephone | 574-319-1420
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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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