Primary Care Pc

NPI 1013029883 - Family Medicine - 207Q00000X

NPI Details
NPI 1013029883
Enumeration Date 08/31/2006
Last Updated 08/07/2008
Entity Type Healthcare Provider
Active Over 10 years ago
Authorized Information
Name KENNETH WALTER KENNETH
Position PRESIDENT
Phone (219) 762-3175
Fax (219) 763-3092
Practice Location
3125 WILLOWCREEK ROAD
PORTAGE IN, 46368, US
Phone (219) 762-3175
Fax (219) 763-3092
Business Location
3125 WILLOWCREEK ROAD
PORTAGE IN, 46368, US
Phone (219) 762-3175
Fax (219) 763-3092
Toxanomy
Taxonomy Code 207Q00000X
License State Indiana
License Number 50004219A
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According to our database, Primary Care Pc NPI is 1013029883, taxonomy code is 207Q00000X and license number is 50004219A, license state is located at Indiana. Primary Care Pc physically located at 3125 Willowcreek Road, Portage IN, 46368. NPI Number 1033115704 has the healthcare provider type.

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1013029883 NPI number is provided on an as is basis without warranty of any kind. 1013029883 is maintained by the National Plan & Provider Enumeration System. The contents of Primary Care Pc are for informational purposes only.