| |
51265 Amesburry Way Granger IN 46530-4828 | |
(574) 243-4875 | |
(574) 243-4847 |
Full Name | |
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Speciality | Internal Medicine |
Location | 51265 Amesburry Way, Granger, Indiana |
Authorized Official Name and Position | Shamoon Ahmed (MEDICAL DIRETOR) |
Authorized Official Contact | 5742434875 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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51265 Amesburry Way Granger IN 46530-4828 Ph: (574) 243-4875 | 51265 Amesburry Way Granger IN 46530-4828 Ph: (574) 243-4875 |
NPI Number | 1104985464 |
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Provider Enumeration Date | 12/06/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104985464 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | (Indiana) | Primary |
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