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5838 W Brick Rd Ste 106 South Bend IN 46628-8420 | |
(574) 247-1911 | |
(574) 247-1912 |
Full Name | |
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Speciality | Family Medicine |
Location | 5838 W Brick Rd Ste 106, South Bend, Indiana |
Authorized Official Name and Position | Jeffrey Stevens (OWNER) |
Authorized Official Contact | 2488246600 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Po Box 639295 Dept 93394 Cincinnati OH 45263-9295 Ph: (248) 434-6169 | 5838 W Brick Rd Ste 106 South Bend IN 46628-8420 Ph: (574) 247-1911 |
NPI Number | 1720605884 |
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Provider Enumeration Date | 07/06/2020 |
Last Update Date | 10/21/2022 |
Identifier | Type | State | Issuer |
---|---|---|---|
1720605884 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
208000000X | Pediatrics | (* (Not Available)) | Secondary |
208D00000X | General Practice | (* (Not Available)) | Secondary |
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