# MAGNO MEDICAL LLC

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

## Provider details

- **NPI number:** 1497866198
- **Authorized official:** DR. FAUSTO O MAGNO M.D. (CO-OWNER)
- **Authorized official phone:** (219) 736-1500

## Contact information

- **Practice address:** 8315 VIRGINIA ST, SUITE M, MERRILLVILLE, IN 46410-6238
- **Practice address phone:** (219) 736-1500
- **Practice address fax:** (219) 736-1551
- **Mailing address:** 8315 VIRGINIA ST, SUITE M, MERRILLVILLE, IN 46410-6238
- **Mailing address phone:** (219) 736-1500
- **Mailing address fax:** (219) 736-1551

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 01054491A | IN | Yes |
| 2084N0402X | Neurology with Special Qualifications in Child Neurology Physician | 01036035 | IN | — |

## Other

- **Enumeration date:** 08/31/2006
- **Last updated:** 04/07/2008