Organization
NORTHWEST INDIANA MEDICAL CONSULTANTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSETTE CHERIE JACKSON (OFFICE MANAGER)
(219) 985-2510
Entity
Organization
Contact information
Practice address
5304 BROADWAY, MERRILLVILLE, IN 46410-1555
(219) 985-2510
(219) 985-2532
Mailing address
5304 BROADWAY, MERRILLVILLE, IN 46410-1555
(219) 985-2510
(219) 985-2532
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
01046988
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200148340B
—
IN
Enumeration date
01/23/2007
Last updated
06/25/2010
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