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Organization
ST MARGARET MERCY HEALTHCARE CENTERS
Active
Organization
ST MARGARET MERCY HEALTHCARE CENTERS
Active
Other names
Urosurgery Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS GRYZBEK (PRESIDENT)
(219) 932-2300
Entity
Organization
Contact information
Practice address
5454 HOHMAN AVE, 1 FLOOR C, HAMMOND, IN 46320-1931
(219) 932-5576
(219) 933-2655
Mailing address
PO BOX 1000, DYER, IN 46311-0800
(219) 864-2107
(219) 864-2251
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
NULL
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200159110O
—
IN
01
—
90000854
BCBS
IL
Enumeration date
09/17/2007
Last updated
02/04/2011
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