Organization
ABC PEDIATRIACS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TODD JOHNSON (AR MGR.)
(219) 662-3931
Entity
Organization
Contact information
Practice address
6750 CALUMET AVE, HAMMOND, IN 46324-1646
(219) 803-0311
(219) 803-0217
Mailing address
PO BOX 1154, CROWN POINT, IN 46308-1154
(219) 662-3931
(219) 663-6359
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01053391A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200978100A
—
IN
05
—
305761883
—
IL
Enumeration date
04/16/2010
Last updated
02/15/2011
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