Organization
STREETER MEDICAL-SURGICAL, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS L. STREETER D.O. (PRESIDENT)
(219) 769-6221
Entity
Organization
Contact information
Practice address
119 E 89TH AVE, MERRILLVILLE, IN 46410-7184
(219) 769-6221
Mailing address
119 E 89TH AVE, MERRILLVILLE, IN 46410-7184
(219) 769-6221
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
02000320B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084728
INDIANA ANTHEM
IN
05
—
100166240
—
IN
01
—
9000235
ILLINOIS BLUE CROSS
IL
Enumeration date
11/22/2006
Last updated
10/27/2009
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