Organization
FAMILY MEDICINE ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AUGUSTINE IZAH MD (OWNER)
(219) 884-4450
Entity
Organization
Contact information
Practice address
5857 BROADWAY, MERRILLVILLE, IN 46410-2666
(219) 884-4450
(212) 884-4418
Mailing address
PO BOX 10606, MERRILLVILLE, IN 46411-0606
(219) 884-4450
(219) 884-4418
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01042994
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200523670A
—
IN
Enumeration date
06/22/2007
Last updated
10/28/2013
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