Organization
WILLOW CREEK MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ASHWANI KUMAR M.D. (PRESIDENT)
(219) 762-4999
Entity
Organization
Contact information
Practice address
3156 WILLOWCREEK RD, PORTAGE, IN 46368-4424
(219) 762-4999
(219) 762-2288
Mailing address
3156 WILLOWCREEK RD, PORTAGE, IN 46368-4424
(219) 762-4999
(219) 762-2288
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
010133934B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200237500
—
IN
01
—
CG2594
RAILROAD MEDICARE
—
Enumeration date
01/04/2007
Last updated
12/17/2010
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