Individual
DR. CURTIS L GONGWER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4440 NORTH PORTAGE AVENUE, SOUTH BEND, IN 46628-8579
(574) 204-6200
(574) 288-1426
Mailing address
4440 NORTH PORTAGE AVENUE, SOUTH BEND, IN 46628-8579
(574) 204-6200
(574) 288-1426
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01045301A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200136950
—
IN
Enumeration date
10/25/2005
Last updated
08/02/2016
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