Organization
LAKE PARK CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE JORDAN (OFFICE MANAGER)
(219) 942-1422
Entity
Organization
Contact information
Practice address
1356 S LAKE PARK AVE, HOBART, IN 46342-5964
(219) 942-8518
(219) 947-2751
Mailing address
1356 S LAKE PARK AVE, HOBART, IN 46342-5964
(219) 942-8518
(219) 947-2751
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000086604
BLUE CROSS BLUE SHIELD
IN
01
—
000000550461
ANTHEM
IN
05
—
100159850A
—
IN
Enumeration date
06/25/2007
Last updated
06/13/2014
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