Provider Demographics
NPI:1316179625
Name:FIVE APPLES INPATIENT SPECIALIST INDIANA CORPORATION
Entity Type:Organization
Organization Name:FIVE APPLES INPATIENT SPECIALIST INDIANA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TERRILL
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLEWHTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-937-7962
Mailing Address - Street 1:400 N WALL ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2940
Mailing Address - Country:US
Mailing Address - Phone:815-937-7962
Mailing Address - Fax:815-936-8650
Practice Address - Street 1:600 GRANT ST
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46402-6001
Practice Address - Country:US
Practice Address - Phone:815-937-7962
Practice Address - Fax:815-936-8650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIVE APPLES INPATIENT SPECIALIST
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067111A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty