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General NPI Number Information
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NPI Number | 1942489307
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Entity Type | Organization
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Legal Business Name | RG HALUM JR MD UROLOGY INC
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Dates
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Enumeration Date | 11/01/2007
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Last Update Date | 03/14/2008
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Provider Practice Location Address
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Address Line | 800 MACARTHUR BLVD SUITE 1
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City | MUNSTER
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State | IN
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Zip | 46321-2917
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Country | US
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Telephone | 219-836-5865
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Fax | 219-836-5499
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Provider Business Mailing Address
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Address Line | 800 MACARTHUR BLVD SUITE 1
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City | MUNSTER
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State | IN
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Zip | 46321-2917
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Country | US
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Telephone | 219-836-5865
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Fax | 219-836-5499
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | RAMON HALUM
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Credential | MD
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Telephone | 219-836-5865
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 01021652
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License Number State | IN
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