| Na | |
|
3000 Pepper Creek Bridge Pkwy Valparaiso IN 46385-7129 | |
| (773) 520-1950 | |
| Not Available |
| Full Name | Na |
|---|---|
| Speciality | Internal Medicine |
| Location | 3000 Pepper Creek Bridge Pkwy, Valparaiso, Indiana |
| Authorized Official Name and Position | Bryan E Waldo (OWNER) |
| Authorized Official Contact | 7735201950 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Na 3000 Pepper Creek Bridge Pkwy Valparaiso IN 46385-7129 Ph: (773) 520-1950 | Na 3000 Pepper Creek Bridge Pkwy Valparaiso IN 46385-7129 Ph: (773) 520-1950 |
| NPI Number | 1043994262 |
|---|---|
| Provider Enumeration Date | 06/09/2023 |
| Last Update Date | 06/09/2023 |
| Certification Date | 06/09/2023 |
| Medicare PECOS PAC ID | 9133581572 |
|---|---|
| Medicare Enrollment ID | O20230816002390 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043994262 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Bryan E Waldo |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1982716486 PECOS PAC ID: 7719909456 Enrollment ID: I20080313000123 |
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