Organization
RENAISSANCE WOMENS CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DEBORAH LYNNE MCCULLOUGH MD (CEO/OWNER)
(219) 887-7313
Entity
Organization
Contact information
Practice address
6111 HARRISON ST, SUITE 255, MERRILLVILLE, IN 46410-2969
(773) 887-7313
Mailing address
6111 HARRISON ST, SUITE 255, MERRILLVILLE, IN 46410-2969
(773) 887-7313
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01026315A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084532
ANTHEM
IN
05
—
100147650A
—
IN
Enumeration date
12/26/2007
Last updated
06/27/2008
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