Individual
CAROLINE E BJONBACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
400 LEGACY PLZ W, LA PORTE, IN 46350-5296
(219) 326-1775
(219) 326-1951
Mailing address
PO BOX 1690, LA PORTE, IN 46352-1690
(219) 326-2312
(219) 326-2584
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01044334
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000079447
ANTHEM, BCBS
IN
05
—
200073080
—
IN
Enumeration date
08/01/2006
Last updated
12/23/2014
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