| South Bend Psychiatry Llc | |
|
1800 N Oak Dr Plymouth IN 46563-3406 | |
| (574) 303-5375 | |
| Not Available |
| Full Name | South Bend Psychiatry Llc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 1800 N Oak Dr, Plymouth, Indiana |
| Authorized Official Name and Position | Mallikarjun Patta (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 5743035375 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| South Bend Psychiatry Llc 11106 Birch Lake Dr Granger IN 46530-6032 Ph: (574) 303-5375 | South Bend Psychiatry Llc 1800 N Oak Dr Plymouth IN 46563-3406 Ph: (574) 303-5375 |
| NPI Number | 1700112224 |
|---|---|
| Provider Enumeration Date | 10/19/2009 |
| Last Update Date | 09/15/2021 |
| Certification Date | 09/15/2021 |
| Medicare PECOS PAC ID | 1951440643 |
|---|---|
| Medicare Enrollment ID | O20091210000050 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700112224 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Robert T Raster |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417924879 PECOS PAC ID: 1850430547 Enrollment ID: I20091210000098 |
| Provider Name | Mallikarju N Patta |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1164499554 PECOS PAC ID: 2365472313 Enrollment ID: I20091210000122 |
| Provider Name | Teresa M Benefit |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215380357 PECOS PAC ID: 3577843481 Enrollment ID: I20161212001965 |
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