Individual
MR. JOSE LUIS AGUSTI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4900 E 107TH CT, WINFIELD, IN 46307-2862
(219) 386-5018
(219) 472-0089
Mailing address
4900 E 107TH CT, WINFIELD, IN 46307-2862
(219) 900-3990
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01061624A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000488177
ANTHEM
IN
01
—
01621679
BCBS OF IL
IL
05
—
036101129 / 05
—
IL
05
—
200832510
—
IN
Enumeration date
11/28/2005
Last updated
12/03/2024
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