Organization
NEIL WANGSTROM MD PC
Active
Other names
Northwest Indiana ENT Assoicates
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROBIN M HENRICH CMPC (PRACTICE MANAGER)
(219) 325-3770
Entity
Organization
Contact information
Practice address
304 DETROIT ST, LA PORTE, IN 46350-2473
(219) 325-3770
(219) 325-8181
Mailing address
304 DETROIT ST, LA PORTE, IN 46350-2473
(219) 325-3770
(219) 325-8181
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01038858
IN
231H00000X
Audiologist
23002292A
IN
363L00000X
Nurse Practitioner
71001701A
IN
363L00000X
Nurse Practitioner
71001740A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000105404
ANTHEM
IN
05
—
100165330
—
IN
05
—
100165330A
—
IN
05
—
200245050A
—
IN
05
—
200482190
—
IN
Enumeration date
10/10/2006
Last updated
09/29/2009
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