MEDICARE: INDIANA HOME CARE PHYSICIANS INC

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	207QG0300X	Geriatric Medicine (Family Medicine) Physician

General Provider Information

NPI Number	:	1396002408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANA HOME CARE PHYSICIANS INC

Provider Business Mailing Address
First Line	:	7895 BROADWAY STE V
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-5529
Country	:	US
Telephone Number	:	219-980-3181
Fax Number	:	219-359-1837

Provider Business Practice Location Address
First Line	:	7895 BROADWAY STE V
Second Line	:
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-5529
Country	:	US
Telephone Number	:	219-980-3181
Fax Number	:	219-359-1837

Authorized Official
Title or Position	:	MANAGING DIRECTOR
Name	:	MR. EUGENE LAZATIN
Credential	:
Telephone Number	:	630-917-1062

Provider Enumeration Date	:	04/13/2012
Last Update Date	:	02/25/2019

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