Individual
CYNTHIA M PHELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1300 STATE ST, SUITE 2E, LA PORTE, IN 46350-3185
(219) 326-5700
(219) 326-8131
Mailing address
PO BOX 1690, LA PORTE, IN 46352-1690
(219) 326-2312
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01061246A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000379262
ANTHEM, BCBS
IN
05
—
200284520
—
IN
Enumeration date
07/26/2006
Last updated
08/05/2008
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