# ALBERT WILLARDO MD

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

## Provider details

- **NPI number:** 1619155926
- **Authorized official:** ALBERT WILLARDO MD (OWNER/PHYSICIAN)
- **Authorized official phone:** (219) 845-2030

## Contact information

- **Practice address:** 7150 INDIANAPOLIS BLVD, HAMMOND, IN 46324-2245
- **Practice address phone:** (219) 845-2030
- **Practice address fax:** (219) 989-0257
- **Mailing address:** 55 E 86TH AVE, PO BOX 10645, MERRILLVILLE, IN 46410-6382
- **Mailing address phone:** (219) 769-1670
- **Mailing address fax:** (219) 738-6714

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 01020554 | IN | Yes |

## Other

- **Enumeration date:** 02/08/2008
- **Last updated:** 02/08/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100161690A | — | IN |