Organization
MBWOUDE, INC.
Active
Other names
APT Plus
Organization subpart
No
Provider details
NPI number
Authorized official
JEANNE M WATERFIELD (DIRECTOR OF OFFICE ADMINISTRATION)
(219) 864-3300
Entity
Organization
Contact information
Practice address
1100 JOLIET ST, SUITE 105, DYER, IN 46311-1996
(219) 864-3300
(219) 864-2569
Mailing address
1100 JOLIET ST, SUITE 205, DYER, IN 46311-1996
(219) 864-3300
(219) 864-2569
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000324507
ANTHEM BCBS
IN
01
—
0586236
CIGNA
IN
01
—
164465
INDIANA DEPT OF HEALTH
IN
01
—
5195522
AETNA
IN
01
—
90001153
BC OF ILLINOIS
IN
Enumeration date
05/20/2006
Last updated
08/22/2020
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