Organization
MISHAWAKA ORTHOPEDICS AND SPORTS MEDICINE P C
Active
Organization
MISHAWAKA ORTHOPEDICS AND SPORTS MEDICINE P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES MCDONALD WARE JR. M.D. (PRESIDENT)
(574) 271-5151
Entity
Organization
Contact information
Practice address
270 E DAY RD, STE 200, MISHAWAKA, IN 46545-3444
(574) 271-5151
(574) 271-5175
Mailing address
270 E DAY RD, STE 200, MISHAWAKA, IN 46545-3444
(574) 271-5151
(574) 271-5175
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
50003916A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000104753
BC/BS
IN
05
—
200248370A
—
IN
01
—
CE8821
RR MEDICARE
GA
Enumeration date
09/15/2005
Last updated
03/17/2015
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