Individual
MERVIN C STOVER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
513 RIDGE RD, MUNSTER, IN 46321-1647
(219) 836-5738
(219) 836-5782
Mailing address
PO BOX 1000, DYER, IN 46311-0800
(219) 864-2107
(219) 864-2649
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01024290A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100141140
—
IN
01
—
90000854
BCBSIL GROUP NUMBER
IL
Enumeration date
10/03/2005
Last updated
07/19/2011
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