Individual
HENRY M ANDOH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
757 45TH AVE, STE. 201, MUNSTER, IN 46321-2911
(219) 934-2461
(219) 934-2478
Mailing address
761 45TH AVE, STE. 103, MUNSTER, IN 46321-2893
(219) 922-3002
(219) 922-3003
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
01042402A
IN
207RI0200X
Infectious Disease Physician
36-083429
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001606805
BLUE CROSS BLUE SHIELD
IL
01
—
0004542266
AETNA
IL
01
—
110108462
RAILROAD MEDICARE
IL
05
—
200009960B
—
IN
Enumeration date
11/17/2006
Last updated
05/19/2021
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