Organization
SACRIS MEDICAL CORPORATION PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL H DELA VINA (OFFICE MANAGER)
(219) 462-4042
Entity
Organization
Contact information
Practice address
2000 ROOSEVELT RD, SUITE 207, VALPARAISO, IN 46383-2800
(219) 462-4042
(219) 462-1444
Mailing address
PO BOX 1338, VALPARAISO, IN 46384-1338
(219) 462-4042
(219) 462-1444
Taxonomy
Speciality
Code
Description
License number
State
207VH0002X
Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician
Primary
01025728
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000109115
BLUE CROSS OF INDIANA
IN
05
—
100076930A
—
IN
01
—
90000239
BLUE CROSS OF ILLINOIS
IN
Enumeration date
05/07/2007
Last updated
10/01/2008
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