| Family Medicine Of South Bend Pc | |
|
610 N Michigan Street Suite 308 South Bend IN 46601 | |
| (574) 239-4602 | |
| (574) 239-4607 |
| Full Name | Family Medicine Of South Bend Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 610 N Michigan Street, South Bend, Indiana |
| Authorized Official Name and Position | Ana S Cardenas (PRESIDENT) |
| Authorized Official Contact | 5742394602 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Family Medicine Of South Bend Pc 610 N Michigan Street Suite 308 South Bend IN 46601 Ph: (574) 239-4602 | Family Medicine Of South Bend Pc 610 N Michigan Street Suite 308 South Bend IN 46601 Ph: (574) 239-4602 |
| NPI Number | 1356432538 |
|---|---|
| Provider Enumeration Date | 09/27/2006 |
| Last Update Date | 07/09/2008 |
| Medicare PECOS PAC ID | 5395659882 |
|---|---|
| Medicare Enrollment ID | O20031118000869 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356432538 | NPI | - | NPPES |
| 100090560A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (Indiana) | Primary |
| Provider Name | Ilana L Kirsch |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1508857806 PECOS PAC ID: 3476541194 Enrollment ID: I20040503000834 |
| Provider Name | Brian A Jacobs |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437240694 PECOS PAC ID: 2466421185 Enrollment ID: I20040929000951 |
| Provider Name | Natalie J Frentz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1194941708 PECOS PAC ID: 9032219951 Enrollment ID: I20070706000428 |
| Provider Name | Donald R Troyer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1427149624 PECOS PAC ID: 6507909033 Enrollment ID: I20100722000162 |
| Provider Name | John M Jacobs |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881785046 PECOS PAC ID: 4789727215 Enrollment ID: I20100805000458 |
| Provider Name | Frederick D Scheel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801987003 PECOS PAC ID: 7416090949 Enrollment ID: I20100805000517 |
| Provider Name | Kari D Sears |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548556111 PECOS PAC ID: 0446405989 Enrollment ID: I20150904002195 |
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