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Organization
MIDWEST MOBILE MEDICAL GROUP PC
Active
Organization
MIDWEST MOBILE MEDICAL GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHAN TRUCHAN DPM (CEO/MEDICAL DIRECTOR)
(219) 840-0345
Entity
Organization
Contact information
Practice address
2 SPECTACLE DR, VALPARAISO, IN 46383-1053
(219) 840-0345
Mailing address
2 SPECTACLE DR, VALPARAISO, IN 46383-1053
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000937A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201213580A
—
IN
Enumeration date
01/17/2014
Last updated
05/28/2014
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