| |
6913 N Main St Ste 300 Granger IN 46530-8039 | |
(574) 647-1500 | |
(574) 647-2567 |
Full Name | |
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Speciality | Family Medicine |
Location | 6913 N Main St Ste 300, Granger, Indiana |
Authorized Official Name and Position | Jeffrey Costello (VP-CFO) |
Authorized Official Contact | 5746473549 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3245 Health Dr Ste 100 Granger IN 46530-1380 Ph: () - | 6913 N Main St Ste 300 Granger IN 46530-8039 Ph: (574) 647-1500 |
NPI Number | 1053361543 |
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Provider Enumeration Date | 05/12/2006 |
Last Update Date | 08/26/2024 |
Identifier | Type | State | Issuer |
---|---|---|---|
1053361543 | NPI | - | NPPES |
300002852 | Medicaid | IN | |
100224050C | Medicaid | IN | |
300015362 | Medicaid | IN |
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