| - | |
|
209 E 86th Ct Merrillville IN 46410-6529 | |
| (219) 736-9042 | |
| (219) 942-9247 |
| Full Name | - |
|---|---|
| Speciality | Internal Medicine |
| Location | 209 E 86th Ct, Merrillville, Indiana |
| Authorized Official Name and Position | Mary F Sudicky (CFO) |
| Authorized Official Contact | 2199420551 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| - 164 Bracken Pkwy Hobart IN 46342-6789 Ph: (219) 947-6780 | - 209 E 86th Ct Merrillville IN 46410-6529 Ph: (219) 736-9042 |
| NPI Number | 1851306690 |
|---|---|
| Provider Enumeration Date | 07/30/2006 |
| Last Update Date | 06/15/2010 |
| Medicare PECOS PAC ID | 2365424348 |
|---|---|
| Medicare Enrollment ID | O20040603000490 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851306690 | NPI | - | NPPES |
| 200251650I | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Barbara A Chavez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831269901 PECOS PAC ID: 5698835593 Enrollment ID: I20081121000657 |
| Provider Name | Dyanna Jm Hamstra Prairie |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1144667825 PECOS PAC ID: 4486897956 Enrollment ID: I20130830000735 |
| Provider Name | Mary P Kustron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720568017 PECOS PAC ID: 9537406418 Enrollment ID: I20190130002923 |
| Provider Name | Christina M Korem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689145567 PECOS PAC ID: 1658612502 Enrollment ID: I20190403001017 |
| Provider Name | Patricia Biel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063031367 PECOS PAC ID: 3971924648 Enrollment ID: I20200604001813 |
| Provider Name | Addison M Boardman |
|---|---|
| Provider Type | Practitioner - Qualified Audiologist |
| Provider Identifiers | NPI Number: 1447858527 PECOS PAC ID: 8921418922 Enrollment ID: I20201103000807 |
Uwc- Merrillville Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 616 W 81st Ave Ste A, Merrillville, IN 46410 Phone: 312-421-1016 Fax: 219-255-9588 | |
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Northshore Regional Health Centers Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 8555 Taft St, Merrillville, IN 46410 Phone: 219-763-8112 Fax: 219-764-3251 | |
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