Individual
EMMANUEL THIERRY MENTOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
650 DICKINSON RD, CHESTERTON, IN 46304-3387
(219) 926-7755
(219) 929-1885
Mailing address
809 LAPORTE AVE, VALPARAISO, IN 46383-5801
(219) 263-4977
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01073933A
IN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/06/2014
Last updated
11/14/2018
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