Individual
MRS. JILL BROGDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
5522 E 989 N, DEMOTTE, IN 46310-8016
(219) 756-4695
Mailing address
3396 W LAKESHORE DR, CROWN POINT, IN 46307-8922
(219) 898-3422
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
31000073A
IN
Other
Enumeration date
02/27/2007
Last updated
07/08/2007
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