Organization
NORTHWEST CENTER MEDICAL SERVICES CORP
Active
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
Update your record
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