MEDICARE: MONROE MEDICAL ASSOCIATES SC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	036056161	IN

General Provider Information

NPI Number	:	1003078817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONROE MEDICAL ASSOCIATES SC PC

Provider Business Mailing Address
First Line	:	801 MACARTHUR BLVD
Second Line	:	SUITE 401
City	:	MUNSTER
State	:	IN
Zip	:	46321-2915
Country	:	US
Telephone Number	:	219-836-2860
Fax Number	:

Provider Business Practice Location Address
First Line	:	9250 COLUMBIA AVE
Second Line	:	SUITE D2
City	:	MUNSTER
State	:	IN
Zip	:	46321-3538
Country	:	US
Telephone Number	:	219-836-7763
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK F KOZLOFF
Credential	:	MD
Telephone Number	:	708-339-4800

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	07/02/2008

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