| Porter Physician Services Llc | |
|
3630 Willowcreek Rd Portage IN 46368-5075 | |
| (219) 759-5791 | |
| (219) 759-3807 |
| Full Name | Porter Physician Services Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3630 Willowcreek Rd, Portage, Indiana |
| Authorized Official Name and Position | Debbie T Brewer (DIRECTOR OF PROVIDER ENROLLMENT) |
| Authorized Official Contact | 6154657626 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Porter Physician Services Llc 3630 Willowcreek Rd Portage IN 46368-5075 Ph: (219) 759-5791 | Porter Physician Services Llc 3630 Willowcreek Rd Portage IN 46368-5075 Ph: (219) 759-5791 |
| NPI Number | 1457566309 |
|---|---|
| Provider Enumeration Date | 05/14/2007 |
| Last Update Date | 01/28/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457566309 | NPI | - | NPPES |
| 200866880A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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