Organization
NORTHWEST CENTER MEDICAL SERVICES CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN ILGENFRITZ (SECRETARY, BOARD OF DIRECTORS)
(219) 980-6699
Entity
Organization
Contact information
Practice address
3400 BROADWAY, GARY, IN 46408-1101
(219) 980-6699
(219) 980-6693
Mailing address
3400 BROADWAY, GARY, IN 46408-1101
(219) 980-6699
(219) 980-6693
Taxonomy
Speciality
Code
Description
License number
State
207SC0300X
Clinical Cytogenetics Physician
Primary
01034266A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100471020A
—
IN
Enumeration date
06/10/2008
Last updated
06/10/2008
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