Organization
DERMATOLOGY CENTER OF NORTHWEST INDIANA, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MITCHELL LESLIE BRESSACK M.D. (OWNER)
(219) 662-8856
Entity
Organization
Contact information
Practice address
70 W 94TH PL, CROWN POINT, IN 46307-1710
(219) 662-8822
(219) 662-8833
Mailing address
70 W 94TH PL, CROWN POINT, IN 46307-1710
(219) 662-8822
(219) 662-8833
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
01031629A
IN
207N00000X
Dermatology Physician
02004576A
IN
207ND0900X
Dermatopathology Physician
01043884A
IN
363AM0700X
Medical Physician Assistant
10000889A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100214910A
—
IN
05
—
200039710A
—
IN
05
—
201294150
—
IN
Enumeration date
01/07/2016
Last updated
01/07/2016
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