Organization
NORTH CENTRAL INDIANA MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE WILSON (PRACTICE MANAGER)
(574) 832-6246
Entity
Organization
Contact information
Practice address
112 S MAIN ST, MILFORD, IN 46542-3006
(574) 832-6246
Mailing address
PO BOX 247, MILFORD, IN 46542-0247
(574) 832-6246
(574) 832-2011
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902-89-0718
OB/GYN
IN
Enumeration date
02/26/2020
Last updated
08/06/2020
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