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3500 S Lafountain St Kokomo IN 46902-3803 | |
(765) 453-0702 | |
Not Available |
Full Name | |
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Speciality | General Practice |
Location | 3500 S Lafountain St, Kokomo, Indiana |
Authorized Official Name and Position | Thomas M Cook (CFO/VP OF FINANCE) |
Authorized Official Contact | 7654538179 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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3500 S Lafountain St Kokomo IN 46902-3803 Ph: (765) 453-0702 | 3500 S Lafountain St Kokomo IN 46902-3803 Ph: (765) 453-0702 |
NPI Number | 1679805113 |
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Provider Enumeration Date | 02/09/2010 |
Last Update Date | 02/09/2010 |
Identifier | Type | State | Issuer |
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1679805113 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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208D00000X | General Practice | (Indiana) | Primary |
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