Organization
COSMETIC AND PLASTIC SURGERY OF NORTHWEST INDIANA PC
Active
Parent organization
COSMETIC AND PLASTIC SURGERY OF NORTHWEST INDIANA PC
Organization subpart
Yes
Provider details
NPI number
Legal business name
COSMETIC AND PLASTIC SURGERY OF NORTHWEST INDIANA PC
Authorized official
MR. MICHAEL CRAIG MALCZEWSKI MD (PRESIDENT)
(219) 945-0669
Entity
Organization
Contact information
Practice address
7865 N GRAND BLVD, HOBART, IN 46342-6665
(219) 945-0669
(219) 945-5669
Mailing address
7865 N GRAND BLVD, HOBART, IN 46342-6665
(219) 945-0669
(219) 945-5669
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
01043550A
IN
208200000X
Plastic Surgery Physician
Primary
01043550A
—
2086S0105X
Surgery of the Hand (Surgery) Physician
01043550A
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200025060A
—
IN
05
—
200253570L
—
IN
Enumeration date
03/10/2008
Last updated
06/30/2008
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