Provider Demographics
NPI:1013191139
Name:MAW MEDICINE PC
Entity Type:Organization
Organization Name:MAW MEDICINE PC
Other - Org Name:MICHAEL A. WOODS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-689-6637
Mailing Address - Street 1:709 PLAZA DR STE 2
Mailing Address - Street 2:SUITE 164
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-1573
Mailing Address - Country:US
Mailing Address - Phone:219-689-6637
Mailing Address - Fax:
Practice Address - Street 1:802 LAPORTE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5860
Practice Address - Country:US
Practice Address - Phone:219-477-5242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048590A261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE3546OtherRAILROAD MEDICARE
IN1225130867OtherPER SONANPI-MICHAEL WOODS
IN200203200Medicaid
IN1225130867OtherPER SONANPI-MICHAEL WOODS
DE3546OtherRAILROAD MEDICARE