Mikael Denise Howard, | |
52500 Fir Rd, Granger, IN 46530-8579 | |
(574) 204-7050 | |
(574) 204-7047 |
Full Name | Mikael Denise Howard |
---|---|
Gender | Female |
Speciality | Pediatrics |
Location | 52500 Fir Rd, Granger, Indiana |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1114243573 | NPI | - | NPPES |
201249390 | Medicaid | IN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 01074276A (Indiana) | Primary |
Entity Name | The South Bend Clinic Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1073680419 PECOS PAC ID: 3779577937 Enrollment ID: O20040412000439 |
Mailing Address | Practice Location Address |
---|---|
Mikael Denise Howard, 52500 Fir Rd, Granger, IN 46530-8579 Ph: (574) 204-7050 | Mikael Denise Howard, 52500 Fir Rd, Granger, IN 46530-8579 Ph: (574) 204-7050 |
Dr. Shanna Verma Kautzmann, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 6913 N Main St Ste 200, Granger, IN 46530 Phone: 574-647-4540 Fax: 574-647-2567 | |
Dr. Charisse D Johnson, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 229 Florence Ave Ste 233, Granger, IN 46530 Phone: 574-855-4575 Fax: 833-314-0410 | |
Dr. Karen D. Davis, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 6913 N Main St, Granger, IN 46530 Phone: 574-647-2970 Fax: 574-647-2971 | |
Nancy Anne Pudlo, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 6913 N Main St Ste 200, Granger, IN 46530 Phone: 574-647-4540 Fax: 574-647-2971 | |
Dr. Michael James Hudson, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 6913 N Main St, Granger, IN 46530 Phone: 574-647-1500 Fax: 574-243-4343 | |
Melissa Anne Hickey, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 52500 Fir Rd, Granger, IN 46530 Phone: 574-271-0700 Fax: 574-273-5648 |