Organization
PORTER COUNTY INTERNAL MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLA ANNE WEISS (SECRETARY TREASURER)
(219) 464-3941
Entity
Organization
Contact information
Practice address
3705 QUAIL COVEY DRIVE, VALPARAISO, IN 46383-2278
(219) 464-3941
(219) 464-3941
Mailing address
3705 QUAIL COVEY DRIVE, VALPARAISO, IN 46383-2278
(219) 464-3941
(219) 464-3941
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200019300A
—
IN
Enumeration date
09/26/2006
Last updated
09/04/2012
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