# CONCORD FAMILY MEDICINE PC

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

## Provider details

- **NPI number:** 1558462101
- **Authorized official:** ROSEMARY PLANERA (PRATICE MANAGER)
- **Authorized official phone:** (574) 522-1201

## Contact information

- **Practice address:** 25651 COUNTY ROAD 20, ELKHART, IN 46517-2310
- **Practice address phone:** (574) 522-1201
- **Mailing address:** 25651 COUNTY ROAD 20, ELKHART, IN 46517-2310
- **Mailing address phone:** (574) 522-1201

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 04/22/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100113550A | — | IN |