Provider Demographics
NPI:1073554143
Name:PLATIS, JAMES MARK JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARK
Last Name:PLATIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 86TH PL
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6258
Mailing Address - Country:US
Mailing Address - Phone:219-795-1255
Mailing Address - Fax:219-738-1953
Practice Address - Street 1:210 E 86TH PL
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6258
Practice Address - Country:US
Practice Address - Phone:219-795-1255
Practice Address - Fax:219-738-1953
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043292208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000221575OtherANTHEM BCBS
IN200071520Medicaid
IN409460Medicare ID - Type Unspecified
IN000000221575OtherANTHEM BCBS