Organization
MYCARE EXPRESS CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ATIMANAPARAMPIL N. DAMODARAN MD (CFO)
(574) 806-4938
Entity
Organization
Contact information
Practice address
3608 W 80TH LN, MERRILLVILLE, IN 46410-5061
(219) 648-2786
(183) 391-4153
Mailing address
3608 W 80TH LN, MERRILLVILLE, IN 46410-5061
(219) 648-2786
(219) 648-2782
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8941233128
—
IN
Enumeration date
04/07/2020
Last updated
01/18/2022
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