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General NPI Number Information
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NPI Number | 1952587776
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Entity Type | Organization
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Legal Business Name | GAMA PC INC
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Dates
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Enumeration Date | 01/10/2008
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 9250 COLUMBIA AVE STE 2A
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City | MUNSTER
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State | IN
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Zip | 46321
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Country | US
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Telephone | 219-513-1300
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Fax | 219-513-2385
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Provider Business Mailing Address
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Address Line | 9250 COLUMBIA AVE STE 2A
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City | MUNSTER
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State | IN
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Zip | 46321
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Country | US
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Telephone | 219-513-1300
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Fax | 219-513-2385
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Authorized Official
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Title or Position | PRESIDENT
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Name | JEFFREY YESSENOW
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Credential | MD
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Telephone | 219-513-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 01030811A
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License Number State | IN
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