| John Alexander Israel Consulting Inc | |
|
1401 S Woodland Ave Ste 3 Michigan City IN 46360-7189 | |
| (219) 877-4954 | |
| Not Available |
| Full Name | John Alexander Israel Consulting Inc |
|---|---|
| Speciality | Psychologist |
| Location | 1401 S Woodland Ave Ste 3, Michigan City, Indiana |
| Authorized Official Name and Position | Tracy L Freeze (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 2199268320 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John Alexander Israel Consulting Inc Po Box 2257 Chesterton IN 46304-0357 Ph: (219) 926-8320 | John Alexander Israel Consulting Inc 1401 S Woodland Ave Ste 3 Michigan City IN 46360-7189 Ph: (219) 877-4954 |
| NPI Number | 1942438718 |
|---|---|
| Provider Enumeration Date | 06/30/2009 |
| Last Update Date | 12/03/2012 |
| Medicare PECOS PAC ID | 9335279884 |
|---|---|
| Medicare Enrollment ID | O20100610000475 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942438718 | NPI | - | NPPES |
| 000000522563 | Other | IN | ANTHEM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | 20042094A (Indiana) | Primary |
| Provider Name | John A Israel |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1457429722 PECOS PAC ID: 1658401104 Enrollment ID: I20100610000551 |
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