Individual
JORGE FERNANDEZ DECORDOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
901 MACARTHUR, MUNSTER, IN 46321-2901
(219) 836-4622
Mailing address
PO BOX 10805, MERRILLVILLE, IN 46410-0805
(800) 288-8325
(419) 866-5453
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
01045112A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200131350
—
IN
Enumeration date
09/19/2005
Last updated
12/17/2012
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