Individual
DOUGLAS C DEDELOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1400 S LAKE PARK AVE, STE 205, HOBART, IN 46342-6790
(219) 942-8620
(219) 942-6356
Mailing address
9660 WICKER AVENUE, ST JOHN, IN 46373-9487
(219) 226-2203
(219) 226-2202
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
02001822A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200127880
—
IN
01
—
256700A
MEDICARE PTAN
IN
Enumeration date
07/29/2005
Last updated
07/29/2010
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