# LAKE-PORTER CARDIOVASCULAR PC

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

## Provider details

- **NPI number:** 1972694669
- **Authorized official:** MARCIA POWERS (OFFICE MANAGER)
- **Authorized official phone:** (219) 477-4452

## Contact information

- **Practice address:** 2000 ROOSEVELT RD STE 101, VALPARAISO, IN 46383-2801
- **Practice address phone:** (219) 462-1619
- **Practice address fax:** (219) 548-0867
- **Mailing address:** 2000 ROOSEVELT RD STE 101, VALPARAISO, IN 46383-2801
- **Mailing address phone:** (219) 462-1619
- **Mailing address fax:** (219) 548-0867

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 50000940A | IN | Yes |

## Other

- **Enumeration date:** 09/27/2006
- **Last updated:** 12/12/2019