Organization
NORTHEAST INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA GILMORE (BUSINESS OFFICE MANAGER)
(260) 463-2133
Entity
Organization
Contact information
Practice address
2500 N DETROIT ST, LAGRANGE, IN 46761-1158
(260) 463-2133
Mailing address
PO BOX 236, LAGRANGE, IN 46761-0236
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
71004993A
IN
Other
Enumeration date
07/17/2014
Last updated
02/27/2019
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