Organization
FAMILY SPECIALTY MEDICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WAIL E ASFOUR M.D. (OWNER/PHYSICIAN)
(219) 923-9200
Entity
Organization
Contact information
Practice address
3747 45TH ST, HIGHLAND, IN 46322-3008
(219) 923-9200
(219) 922-5904
Mailing address
3747 45TH ST, HIGHLAND, IN 46322-3008
(219) 923-9200
(219) 922-5904
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01053031A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01053031A
—
IN
Enumeration date
07/08/2016
Last updated
04/12/2019
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