Organization
TEOFILO S. BAUTISTA, M.D., P.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TEOFILO BAUTISTA M.D. (PRESIDENT)
(219) 938-4481
Entity
Organization
Contact information
Practice address
642 S LAKE ST, GARY, IN 46403-2967
(219) 938-4481
(219) 938-6480
Mailing address
642 S LAKE ST, GARY, IN 46403-2967
(219) 938-4481
(219) 938-6480
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
01032450A
IN
Other
Enumeration date
12/12/2007
Last updated
12/12/2007
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