Organization
GOSHEN FAMILY PHYSICIANS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. KATHY E MCCLANE (CREDENTIALING COORDINATOR)
(574) 534-0050
Entity
Organization
Contact information
Practice address
1811 CHARLTON CT, GOSHEN, IN 46526-6464
(574) 534-8200
(574) 534-0411
Mailing address
1811 CHARLTON CT, GOSHEN, IN 46526-6464
(574) 534-8200
(574) 534-0411
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300085359
—
IN
Enumeration date
10/24/2006
Last updated
02/01/2024
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