Individual
EPIFANIO GLORIA SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3903 INDIANAPOLIS BLVD, EAST CHICAGO, IN 46312-2555
(219) 398-7050
(219) 392-6998
Mailing address
8400 LOUISIANA ST, MERRILLVILLE, IN 46410-6385
(219) 757-1928
(219) 757-1950
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
01030388A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000213350
ANTHEM BC/BS
IN
05
—
100325110
—
IN
Enumeration date
08/16/2005
Last updated
05/17/2011
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