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General NPI Number Information
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NPI Number | 1962640821
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Entity Type | Organization
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Legal Business Name | SPECIAL MEDICINE CLINIC
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Dates
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Enumeration Date | 01/30/2009
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Last Update Date | 01/30/2009
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Provider Practice Location Address
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Address Line | 1501 WABASH ST STE 303
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-4355
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Country | US
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Telephone | 219-874-8711
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Fax | 219-874-9075
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Provider Business Mailing Address
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Address Line | 1501 WABASH ST STE 303
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City | MICHIGAN CITY
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State | IN
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Zip | 46360-4355
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Country | US
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Telephone | 219-874-8711
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Fax | 219-874-9075
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. BINA GUPTA
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Credential |
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Telephone | 219-874-8711
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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 | 01029292A
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License Number State | IN
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