Individual
JON D MISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
13963 MORSE STREET, CEDAR LAKE, IN 46303-9639
(219) 374-5555
(219) 374-6669
Mailing address
13963 MORSE STREET, CEDAR LAKE, IN 46303-9639
(219) 374-5555
(219) 374-6669
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02000900A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000087109
ANTHEM PROVIDER #
IN
01
—
90000256
BLUE CROSS/BLUE SHIELD IL
IN
Enumeration date
11/17/2005
Last updated
04/19/2010
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