Organization
MEDICAL SURGICAL WELLNESS CENTER, L.L.C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DENNIS L. STREETER D.O. (PRESIDENT)
(219) 791-9782
Entity
Organization
Contact information
Practice address
300 W 80TH PL, SUITE A, MERRILLVILLE, IN 46410-5456
(219) 791-9782
(219) 791-9787
Mailing address
300 W 80TH PL, SUITE A, MERRILLVILLE, IN 46410-5456
(219) 791-9782
(219) 791-9787
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
020000320B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084728
ANTHEM
IN
01
—
9000235
ILLINOIS BLUE CROSS/BLUE SHIELD
IL
Enumeration date
10/27/2009
Last updated
04/01/2014
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