Organization
360 INTEGRATED MEDICAL CENTER, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW KIRKHAM (OWNER)
(219) 326-5100
Entity
Organization
Contact information
Practice address
2504 MONROE ST, LA PORTE, IN 46350-5241
(219) 326-5100
(219) 326-0180
Mailing address
2504 MONROE ST, LA PORTE, IN 46350-5241
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Enumeration date
12/19/2018
Last updated
12/19/2018
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