| Medina Healthcare Sc | |
|
932 Richard Rd Dyer IN 46311-1936 | |
| (219) 515-2148 | |
| Not Available |
| Full Name | Medina Healthcare Sc |
|---|---|
| Speciality | Internal Medicine |
| Location | 932 Richard Rd, Dyer, Indiana |
| Authorized Official Name and Position | Katie A Werner (CREDENTIALING) |
| Authorized Official Contact | 6302619286 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medina Healthcare Sc 932 Richard Rd Dyer IN 46311-1936 Ph: (708) 982-1544 | Medina Healthcare Sc 932 Richard Rd Dyer IN 46311-1936 Ph: (219) 515-2148 |
| NPI Number | 1487975900 |
|---|---|
| Provider Enumeration Date | 06/18/2010 |
| Last Update Date | 12/05/2023 |
| Medicare PECOS PAC ID | 9133304579 |
|---|---|
| Medicare Enrollment ID | O20110428000048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487975900 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 036089606 (Illinois) | Primary |
| Provider Name | Huma Tazeem Mulk |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1497884027 PECOS PAC ID: 6406031848 Enrollment ID: I20110428000060 |
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