Organization
CHILDREN'S CLINIC MUNSTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. S DAMAN PAUL MD (OWNER)
(219) 836-1855
Entity
Organization
Contact information
Practice address
8224 CALUMET AVE, MUNSTER, IN 46321-1704
(219) 836-1855
(219) 836-0527
Mailing address
8224 CALUMET AVE, MUNSTER, IN 46321
(219) 836-1855
(219) 836-0527
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01026157
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000088303
ANTHEM BC/BS
IN
05
—
100316230A
—
IN
01
—
91115202
BC/BS IL
IN
Enumeration date
08/16/2006
Last updated
06/13/2008
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