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LUTHERAN MEDICAL GROUP LLC

Physicians Internal Medicine

Provider NPI: 1164662805

Organization Information:
Organization Name:  LUTHERAN MEDICAL GROUP LLC
Organization is not Subpart
Authorized Official:  MICHAEL A. SWAW  DIRECTOR  615-778-8076

Practice Location:
7916 W JEFFERSON BLVD  FORT WAYNE, IN 46804-4140 US
Tel: 260-432-2297  Fax: --

Business Mailing Address:
PO BOX 689022  FRANKLIN, TN 37068-9022 US
Tel: (88-8) -304-1116  Fax: 615-465-2984

NPI Information:
NPI: 1164662805
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N207R00000XPhysicians
Internal Medicine
N207RA0201XPhysicians
Internal Medicine
N207RC0001XPhysicians
Internal Medicine
N207RP1001XPhysicians
Internal Medicine
N207RR0500XPhysicians
Internal Medicine
N207RS0012XPhysicians
Internal Medicine
N207UN0901XPhysicians
Nuclear Medicine
N363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
N363L00000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner
Y207RC0000XPhysicians
Internal Medicine

Other Provider Identifiers:

IssuerNumberStateType
200934510IN05
2938843OH05



American Medical Association 2012 taxonomy code information

Code: 207RC0000X

Type:

Classification:



Definition:



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