# PRIMARY CARE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013029883
- **Authorized official:** DR. KENNETH WALTER BLUMENTHAL DO (PRESIDENT)
- **Authorized official phone:** (219) 762-3175

## Contact information

- **Practice address:** 3125 WILLOWCREEK ROAD, PORTAGE, IN 46368
- **Practice address phone:** (219) 762-3175
- **Practice address fax:** (219) 763-3092
- **Mailing address:** 3125 WILLOWCREEK ROAD, PORTAGE, IN 46368
- **Mailing address phone:** (219) 762-3175
- **Mailing address fax:** (219) 763-3092

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 50004219A | IN | Yes |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 08/07/2008