| South Ridge Medical | |
|
2421 Laporte Ave Valparaiso IN 46383-6914 | |
| (219) 462-4167 | |
| (219) 462-0426 |
| Full Name | South Ridge Medical |
|---|---|
| Speciality | Pediatrics |
| Location | 2421 Laporte Ave, Valparaiso, Indiana |
| Authorized Official Name and Position | Thomas Gryzbek (PRESIDENT) |
| Authorized Official Contact | 2199322300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Ridge Medical Po Box 1000 Dyer IN 46311-0800 Ph: (219) 864-2107 | South Ridge Medical 2421 Laporte Ave Valparaiso IN 46383-6914 Ph: (219) 462-4167 |
| NPI Number | 1285713438 |
|---|---|
| Provider Enumeration Date | 11/06/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285713438 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208000000X | Pediatrics | (* (Not Available)) | Primary |
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