# DEKALB MEMORIAL HOSPITAL, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DEKALB HEALTH MEDICAL GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073886560
- **Authorized official:** CRAIG POLKOW (CEO)
- **Authorized official phone:** (260) 925-4600

## Contact information

- **Practice address:** 1310 E 7TH ST, SUITE G, AUBURN, IN 46706-2534
- **Practice address phone:** (260) 920-2000
- **Practice address fax:** (260) 920-2005
- **Mailing address:** PO BOX 623, AUBURN, IN 46706-0623
- **Mailing address phone:** (260) 927-8105
- **Mailing address fax:** (260) 927-8026

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Y00000X | Otolaryngology Physician | — | NULL | — |
| 207Y00000X | Otolaryngology Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 02/15/2012
- **Last updated:** 09/13/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100104110I | — | IN |