# DEKALB MEMORIAL HOSPITAL, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DeKalb Health Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871972869
- **Authorized official:** CRAIG POLKOW (CEO)
- **Authorized official phone:** (260) 925-4600

## Contact information

- **Practice address:** 1306 E 7TH ST, SUITE B, AUBURN, IN 46706-2537
- **Practice address phone:** (260) 927-1982
- **Practice address fax:** (260) 927-8380
- **Mailing address:** PO BOX 623, AUBURN, IN 46706-0623
- **Mailing address phone:** (260) 927-8105
- **Mailing address fax:** (260) 333-0664

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/22/2015
- **Last updated:** 09/13/2016

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100104110N | — | IN |