| Willow Creek Medical Llc | |
|
3156 Willowcreek Rd Portage IN 46368-4424 | |
| (219) 762-4999 | |
| (219) 762-2288 |
| Full Name | Willow Creek Medical Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 3156 Willowcreek Rd, Portage, Indiana |
| Authorized Official Name and Position | Ashwani Kumar (PRESIDENT) |
| Authorized Official Contact | 2197624999 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Willow Creek Medical Llc 3156 Willowcreek Rd Portage IN 46368-4424 Ph: (219) 762-4999 | Willow Creek Medical Llc 3156 Willowcreek Rd Portage IN 46368-4424 Ph: (219) 762-4999 |
| NPI Number | 1073660049 |
|---|---|
| Provider Enumeration Date | 01/04/2007 |
| Last Update Date | 12/17/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073660049 | NPI | - | NPPES |
| 200237500 | Medicaid | IN | |
| CG2594 | Other | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 010133934B (Indiana) | Primary |
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