Individual
DR. DENNIS LYNN STREETER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
300 W 80TH PL, SUITE A, MERRILLVILLE, IN 46410-5456
(219) 791-9782
(219) 791-9787
Mailing address
300 W 80TH PL, SUITE A, MERRILLVILLE, IN 46410-5456
(219) 791-9782
(219) 791-9787
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
020000320B
IN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
020000320B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084728
IND BLUE CROSS
IN
05
—
100166240
—
IN
01
—
90000235
ILLINOIS BC/BS
IL
Enumeration date
10/05/2005
Last updated
04/01/2014
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