Organization
DEKALB MEMORIAL HOSPITAL INC
Active
Other names
Dekalb Health
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG POLKOW (CEO)
(260) 920-2501
Entity
Organization
Contact information
Practice address
1310 E 7TH ST, STE B, AUBURN, IN 46706-2534
(260) 920-2501
Mailing address
PO BOX 623, AUBURN, IN 46706-0623
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01039551A
IN
231H00000X
Audiologist
23001905A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191560
MEDICARE PTAN
IN
Enumeration date
12/16/2016
Last updated
12/16/2016
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