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5495 Broadway Merrillville IN 46410-1647 | |
| (219) 884-4900 | |
| (219) 980-7585 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 5495 Broadway, Merrillville, Indiana |
| Authorized Official Name and Position | Danita Johnson Hughes (PRESIDENT/CEO) |
| Authorized Official Contact | 2198854264 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1100 W 6th Ave Gary IN 46402-1711 Ph: (219) 885-4264 | 5495 Broadway Merrillville IN 46410-1647 Ph: (219) 884-4900 |
| NPI Number | 1699225698 |
|---|---|
| Provider Enumeration Date | 10/13/2016 |
| Last Update Date | 11/22/2024 |
| Certification Date | 11/22/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699225698 | NPI | - | NPPES |
| 200030490A | Medicaid | IN |
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