Individual
DR. TEOFILO S BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., P.C.
Contact information
Practice address
642 S LAKE ST, GARY, IN 46403-2967
(219) 938-4481
(219) 938-6480
Mailing address
8135 CALUMET AVE, MUNSTER, IN 46321-1701
(219) 513-2000
(219) 513-2001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01032450
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100169010A
—
IN
Enumeration date
07/12/2005
Last updated
01/29/2013
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