Individual
DR. JAMES P MAUCK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2405 WEST LEXINGTON AVENUE, ELKHART, IN 46514-1417
(574) 524-7575
(574) 524-7576
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-2129
Taxonomy
Speciality
Code
Description
License number
State
207VX0000X
Obstetrics Physician
Primary
01035682
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000082179
ANTHEM BLUE CROSS
IN
05
—
100326890
—
IN
01
—
15432
PHYSICIANS HEALTH PLAN
IN
Enumeration date
06/30/2006
Last updated
05/01/2023
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