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8731 Indianapolis Blvd Highland IN 46322-1551 | |
| (219) 923-2680 | |
| (219) 923-4661 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 8731 Indianapolis Blvd, Highland, Indiana |
| Authorized Official Name and Position | Donald P Fesko (CEO) |
| Authorized Official Contact | 2198361600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
9660 Wicker Ave Saint John IN 46373-9487 Ph: (219) 923-2680 | 8731 Indianapolis Blvd Highland IN 46322-1551 Ph: (219) 923-2680 |
| NPI Number | 1407856412 |
|---|---|
| Provider Enumeration Date | 08/01/2005 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407856412 | NPI | - | NPPES |
| 220289040B | Medicaid | IN | |
| DD5604 | Other | IN | MEDICARE RAILROAD |
| 90000970 | Other | IL | BCBS OF ILLINOIS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Indiana) | Primary |
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