Basic Information
| Provider Information | |||||||||
| NPI: | 1265726673 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DIGESTIVE HEALTHCARE SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8865 W 400 N STE 155 | ||||||||
| Address2: | |||||||||
| City: | MICHIGAN CITY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463609010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198726566 | ||||||||
| FaxNumber: | 2198722712 | ||||||||
| Practice Location | |||||||||
| Address1: | 8865 W 400 N STE 155 | ||||||||
| Address2: | |||||||||
| City: | MICHIGAN CITY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463609010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2198726566 | ||||||||
| FaxNumber: | 2198722712 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2011 | ||||||||
| LastUpdateDate: | 06/02/2011 | ||||||||
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| AuthorizedOfficialLastName: | FUMO | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 2198726566 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.