| Lifecare Of Indiana Llc | |
|
240 Commerce Sq Michigan City IN 46360-3282 | |
| (219) 324-5005 | |
| Not Available |
| Full Name | Lifecare Of Indiana Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 240 Commerce Sq, Michigan City, Indiana |
| Authorized Official Name and Position | Isaac J Leestma (COO / ADMINISTRATOR) |
| Authorized Official Contact | 6168213485 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lifecare Of Indiana Llc 240 Commerce Sq Michigan City IN 46360-3282 Ph: (231) 299-2900 | Lifecare Of Indiana Llc 240 Commerce Sq Michigan City IN 46360-3282 Ph: (219) 324-5005 |
| NPI Number | 1639748692 |
|---|---|
| Provider Enumeration Date | 06/23/2021 |
| Last Update Date | 07/22/2022 |
| Medicare PECOS PAC ID | 9436541018 |
|---|---|
| Medicare Enrollment ID | O20220111000298 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639748692 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Patricia A Wangerin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962442483 PECOS PAC ID: 4981720042 Enrollment ID: I20100925000357 |
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