Organization
LAPORTE REGIONAL PHYSICIAN NETWORK, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK RAFALSKI (COO)
(219) 326-2347
Entity
Organization
Contact information
Practice address
1901 S HEATON, KNOX, IN 46534-2325
(574) 772-3187
(574) 772-4843
Mailing address
P.O. BOX 1690, LAPORTE, IN 46352-1690
(219) 326-2312
(219) 326-2584
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01028450A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01028450A
LICENSE
IN
05
—
100225120
—
IN
05
—
200171580
—
IN
Enumeration date
03/03/2008
Last updated
11/12/2010
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