Organization
PRIMARY CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH WALTER BLUMENTHAL DO (PRESIDENT)
(219) 762-3175
Entity
Organization
Contact information
Practice address
3125 WILLOWCREEK ROAD, PORTAGE, IN 46368
(219) 762-3175
(219) 763-3092
Mailing address
3125 WILLOWCREEK ROAD, PORTAGE, IN 46368
(219) 762-3175
(219) 763-3092
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
50004219A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200272620
—
IN
Enumeration date
08/31/2006
Last updated
08/07/2008
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