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Individual

CARYSIA ROBERTS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LAB DIRECTOR

Contact information

Practice address
720 W 5TH AVE, GARY, IN 46402-1808
(219) 248-4912
Mailing address
804 MARYLAND ST, GARY, IN 46402-2545
(219) 248-4912

Taxonomy

Speciality
Code
Description
License number
State
247ZC0005X
Clinical Laboratory Director (Non-physician)
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1984
GOVERMENT
IL
01
1984
GOVERMENT
IN
05
1984
IL
05
1984
IN
Enumeration date
01/07/2022
Last updated
01/07/2022
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