Provider Demographics
NPI:1033443106
Name:MUNSTER MEDICAL RESEARCH FOUNDATIO
Entity Type:Organization
Organization Name:MUNSTER MEDICAL RESEARCH FOUNDATIO
Other - Org Name:INNOVATIVE WOMENS HEALTH
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:FESKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-836-1600
Mailing Address - Street 1:9660 WICKER AVE
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9487
Mailing Address - Country:US
Mailing Address - Phone:219-365-7620
Mailing Address - Fax:219-226-2285
Practice Address - Street 1:3545 ARBORS STREET
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-4297
Practice Address - Country:US
Practice Address - Phone:219-759-6092
Practice Address - Fax:219-759-6580
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSTER MEDICAL RESEARCH FOUNDATION INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-09-23
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200966130AMedicaid
IN000000642264OtherANTHEM
IN200966130BMedicaid
IN200966130BMedicaid