| Indiana University Northwest | |
|
3400 Broadway Gary IN 46408-1101 | |
| (219) 980-6772 | |
| Not Available |
| Full Name | Indiana University Northwest |
|---|---|
| Speciality | Dentist - Dental Public Health |
| Location | 3400 Broadway, Gary, Indiana |
| Authorized Official Name and Position | Cindy Zak (CLINIC MANAGER) |
| Authorized Official Contact | 2199806772 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Indiana University Northwest 3400 Broadway Gary IN 46408-1101 Ph: (219) 980-6772 | Indiana University Northwest 3400 Broadway Gary IN 46408-1101 Ph: (219) 980-6772 |
| NPI Number | 1912067349 |
|---|---|
| Provider Enumeration Date | 12/08/2006 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912067349 | NPI | - | NPPES |
| 200082120 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0001X | Dentist - Dental Public Health | 0 (Indiana) | Primary |
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