Individual
MARY PREM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7905 CALUMET AVE, MUNSTER, IN 46321-2549
(219) 836-5800
(219) 836-8073
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01063227A
IN
207R00000X
Internal Medicine Physician
MT183455
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200873120
—
IN
01
—
MT183455
GRADUATE MEDICAL TRAINEE
PA
Enumeration date
08/10/2006
Last updated
10/16/2023
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