# MEDICINE REIMAGINED DPC

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

## Provider details

- **NPI number:** 1891375275
- **Authorized official:** DR. KIMBERLY STUCKEY-SCHROCK MD (MANAGER)
- **Authorized official phone:** (574) 319-1420

## Contact information

- **Practice address:** 1720 W LINCOLN AVE, GOSHEN, IN 46526-5906
- **Practice address phone:** (574) 319-1420
- **Mailing address:** 511 N GREENE RD, GOSHEN, IN 46526-1309
- **Mailing address phone:** (574) 319-1420

## Taxonomy

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

## Other

- **Enumeration date:** 04/10/2021
- **Last updated:** 05/05/2021