Organization
HEALTHPARTNERS MEDICAL GROUP, LLC
Active
Other names
HealthPartners
Organization subpart
No
Provider details
NPI number
Authorized official
AMY KELLER (DIRECTOR)
(219) 873-2905
Entity
Organization
Contact information
Practice address
1225 E COOLSPRING AVE, MICHIGAN CITY, IN 46360-6312
(219) 879-6531
(219) 878-5015
Mailing address
35682 EAGLE WAY, CHICAGO, IL 60678-1356
(219) 879-6531
(219) 872-7869
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000347031
ANTHEM
IN
05
—
200489550
—
IN
01
—
DD6703
RR MEDICARE
—
Enumeration date
09/20/2006
Last updated
07/05/2011
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