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General NPI Number Information
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NPI Number | 1912296682
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Entity Type | Organization
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Legal Business Name | PORTER NEONATAL GROUP
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Dates
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Enumeration Date | 04/04/2011
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Last Update Date | 05/25/2011
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Provider Practice Location Address
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Address Line | 814 LAPORTE AVE
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City | VALPARAISO
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State | IN
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Zip | 46383-5860
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Country | US
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Telephone | 219-263-4600
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Fax |
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Provider Business Mailing Address
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Address Line | 2304 KOSSUTH ST
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City | LAFAYETTE
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State | IN
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Zip | 47904-3240
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Country | US
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Telephone | 765-446-9600
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Fax | 765-446-1100
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROSARIO CHUA
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Credential | MD
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Telephone | 765-446-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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