| Teofilo S. Bautista, M.d., P.c | |
|
642 S Lake St Gary IN 46403-2967 | |
| (219) 938-4481 | |
| (219) 938-6480 |
| Full Name | Teofilo S. Bautista, M.d., P.c |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 642 S Lake St, Gary, Indiana |
| Authorized Official Name and Position | Teofilo Bautista (PRESIDENT) |
| Authorized Official Contact | 2199384481 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Teofilo S. Bautista, M.d., P.c 642 S Lake St Gary IN 46403-2967 Ph: (219) 938-4481 | Teofilo S. Bautista, M.d., P.c 642 S Lake St Gary IN 46403-2967 Ph: (219) 938-4481 |
| NPI Number | 1215110200 |
|---|---|
| Provider Enumeration Date | 12/12/2007 |
| Last Update Date | 12/12/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215110200 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 01032450A (Indiana) | Primary |
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