Organization
LAPORTE MEDICAL GROUP SURGICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NEIL WANGSTROM (BOARD CHAIR)
(219) 324-1670
Entity
Organization
Contact information
Practice address
900 I ST, SUITE 1, LA PORTE, IN 46350-5533
(816) 877-2005
Mailing address
900 I ST, SUITE 1, LA PORTE, IN 46350-5533
(219) 324-1670
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
12/18/2008
Last updated
05/20/2020
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