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3831 S Hohman Ave Hammond IN 46327-1160 | |
| (219) 931-1960 | |
| (219) 931-1235 |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 3831 S Hohman Ave, Hammond, Indiana |
| Authorized Official Name and Position | Thomas Gryzbek (PRESIDENT) |
| Authorized Official Contact | 2199322300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1000 Dyer IN 46311-0800 Ph: (219) 864-2107 | 3831 S Hohman Ave Hammond IN 46327-1160 Ph: (219) 931-1960 |
| NPI Number | 1558440149 |
|---|---|
| Provider Enumeration Date | 11/03/2006 |
| Last Update Date | 06/23/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558440149 | NPI | - | NPPES |
| 200159110F | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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