Organization
LAKE PARK SURGICARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. REBECCA MAKSIMOVICH (CLINICAL COORDINATOR)
(219) 942-9600
Entity
Organization
Contact information
Practice address
7921 GRAND BLVD, HOBART, IN 46342-6663
(219) 942-9600
(219) 947-9922
Mailing address
7921 GRAND BLVD, HOBART, IN 46342-6663
(219) 942-9600
(219) 947-9922
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
261QA1903X
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000191299
BLUE CROSS
IN
Enumeration date
10/05/2005
Last updated
08/22/2020
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